ASCO issues guideline to improve germ cell tumor marker use

The American Society of Clinical Oncology has issued a guideline for the use of serum markers in the diagnosis, treatment, and management of germ cell tumors in men, most commonly testicular cancer.

A panel convened by ASCO conducted a systematic review of medical research literature, in partnership with Cancer Care Ontario, to develop the recommendations. The guideline was published online in the Journal of Clinical Oncology (June 7, 2010).

"These guidelines emphasize that germ cell tumor markers can prove enormously useful for staging and monitoring disease when used appropriately," said Timothy D. Gilligan, MD, of Cleveland Clinic, who served as co-chair of ASCO’s Germ Cell Tumor Markers Committee. "Our hope is that this guideline will eliminate confusion and help doctors use serum markers appropriately, and help prevent unnecessary testing."

Specifically, the guideline recommends the following:

• Alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH) should not be used to screen for germ cell tumors, to decide whether orchiectomy is needed, or to make treatment decisions for patients with cancer of unknown origin.
• To determine the stage and prognosis of a testis cancer and to help confirm the diagnosis, AFP, hCG, and LDH should be measured before orchiectomy when a man is suspected of having testicular cancer.
• In men found to have a testicular nonseminoma, AFP, hCG, and LDH should be measured again after orchiectomy and before other treatment begins for testicular cancer, and before chemotherapy for patients with non-seminomas that began outside of the testicles.
• In men found to have a nonseminoma, AFP and hCG should be measured before retroperitoneal lymph node removal, before each cycle of chemotherapy begins, after all chemotherapy is finished, and periodically after treatment ends to watch for a recurrence.
• For patients with testicular pure seminoma, hCG and LDH should be measured again after orchiectomy if they were elevated before.
• Tumor markers should not be used to make or change treatment decisions for seminoma, or to watch for a recurrence of stage I seminoma.
• In men with stage II or III seminoma, hCG and AFP should also be measured when treatment finishes and periodically thereafter to monitor for relapse.