The European Society for Medical Oncology (ESMO) has published an update to its guidance on the diagnosis, treatment and follow-up of testicular seminoma and non-seminoma.
The guideline now states that in patients with poor-risk non-seminoma, alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) should be assessed after one cycle of bleomycin, etoposide and cisplatin (BEP). Patients with an unfavourable marker decline should be considered for treatment with a dose-dense regimen, as in the GETUG 13 study by Fizazi et al, which prospectively assessed the impact of poorly declining tumour markers and identified a chemotherapy regimen superior to four cycles of BEP, for metastatic poor-risk non-seminomatous germ cell tumours and an unfavourable marker decline.
Of 254 patients, 51 (20%) had a favourable marker assessment, and 203 (80%) had an unfavourable tumour marker decline. Among patients with unfavourable marker decline, those treated with the dose-dense regimen demonstrated a significantly better three-year progression-free survival than those treated with standard BEP (59% vs 48%; HR 0.66; 95% CI 0.44-1.00; P=.05).
An online calculator of marker decline is available here. An app is also available.