Salvage chemotherapy better than surgery in patients with elevated tumour markers

Salvage chemotherapy is preferable over surgery in patients with alpha-fetoprotein (AFP) >30 µg/l and human chorionic gonadotropin (HCG) ≥20 mIU/ml after first-line chemotherapy, suggests a study.

“After second- or later-line therapy, the prognosis of patients with elevated markers and surgery is poor regardless of the tumour marker levels,” the investigators said. “However, 38 percent of these patients are long-term survivors, which justifies postchemotherapy (PC) residual tumour resection (RTR) in this setting.”

Overall, 575 PC-RTR procedures performed from July 2018 to July 2019 were assessed. Of these, 153 were carried out in patients with elevated serum tumour markers (STMs; HCG >2.0 mIU/ml, AFP >7.0 µg/l), including 55 after first-line and 98 after second- or later-line chemotherapy.

Viable cancer in the resected specimen was more common in the salvage group than in the first-line group (48.98 percent vs 16.36 percent; p=0.0001988) and was predictive of survival in both groups. A preoperative serum AFP level of ≥30 µg/l was significantly associated with viable cancer in the first-line (55.56 percent; p=0.0157) and salvage groups (66.67 percent; p=0.0017).

In addition, the salvage group had remarkably worse overall relapse-free survival rate (22.7 percent vs 50 percent; p=0.00032) and overall survival rate (37.8 percent vs 65 percent; p=0.0059) than the first-line group.

The predictors of relapse after first-line chemotherapy were a preoperative serum AFP level of ≥30 µg/l and viable cancer or teratoma found in the histological examination of the RTR specimens. Moreover, serum AFP ≥30 µg/l and HCG ≥20 mIU/ml exerted a substantial impact on survival in the first-line group.