Testicular Cancer, Version 2.2015

Motzer, Robert J.; Jonasch, Eric; Agarwal, Neeraj; Beard, Clair J.; Bhayani, Sam B.; Bolger, Graeme B.; Chang, Sam S.; Choueiri, Toni K.; Costello, Brian A.; Derweesh, Ithaar; Gupta, Shilpa; Hancock, Steven; Kim, Jaeyeon; Kuzel, Timothy M.; Lam, Elaine T.; Lau, Clayton; Levine, Ellis G.; Lin, Daniel W.; Michaelson, M. Dror; Olencki, Thomas; Пили, Роберто; Plimack, Elizabeth R.; Rampersaud, Edward N.; Redman, Bruce G.; Ryan, Charles J.; Sheinfeld, Joel; Shuch, Brian; Sircar, Kanishka; Somer, Brad; Wilder, Richard B.; Dwyer, Mary A.; Kumar, Rashmi

doi:10.6004/jnccn.2015.0092

Cited by 100 publications

(95 citation statements)

References 39 publications

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“…This finding is clearly conflicting with the current understanding of germ cell cancer biology since all of the recent guidelines consider an AFP elevation to be equivalent with the diagnosis of non-seminomatous GCT [15,20,21] . The present report indicates that there is a small proportion of patients with pure seminoma who may indeed have non-pathologic AFP elevations.…”

Section: Discussioncontrasting

confidence: 53%

Pure Testicular Seminoma with Non-Pathologic Elevation of Alpha Fetoprotein: A Case Series

Dieckmann¹,

Anheuser²,

Simonsen³

et al. 2017

Urol Int

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Background: Pure testicular seminoma does not express alpha fetoprotein (AFP). However, seminoma patients with mildly elevated serum AFP levels are increasingly reported. As this finding may prompt unwarranted treatment measures, we reviewed our experience with AFP levels in seminoma. Patients and Methods: We retrospectively registered AFP levels in 254 consecutive seminoma patients, and in 196 male controls with non-malignant diseases. In those with elevated AFP levels, we re-examined the orchiectomy specimens histologically. We reviewed the clinical course and looked for hepatic disorders. Results: Elevated AFP levels were found in 5 patients (1.97%, 95% CI 0.19-3.68) and in 4 controls (2.04%, 95% CI 0.06-4.02). The elevations were modest and kept elevated throughout the clinical course. No hepatic disorders were recorded. Histologically, pure seminoma was confirmed. Conclusion: Unspecific AFP elevations occur in about 2% of seminoma patients. Care-givers should be aware of this particular subgroup of seminoma patients to avoid unwarranted treatment burden.

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Section: Discussioncontrasting

confidence: 53%

Pure Testicular Seminoma with Non-Pathologic Elevation of Alpha Fetoprotein: A Case Series

Dieckmann¹,

Anheuser²,

Simonsen³

et al. 2017

Urol Int

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“…Clinical management of testicular germ cell tumors (GCTs) is largely based on the monitoring of serum tumor markers [1,2,3]. However, the markers beta human chorionic gonadotropin (bHCG), alpha fetoprotein (AFP) and lactate dehydrogenase (LDH) are expressed only by 60% of GCTs [4,5,6].…”

Section: Introductionmentioning

confidence: 99%

MicroRNA miR-371a-3p - A Novel Serum Biomarker of Testicular Germ Cell Tumors: Evidence for Specificity from Measurements in Testicular Vein Blood and in Neoplastic Hydrocele Fluid

Dieckmann

Spiekermann²,

Balks³

et al. 2016

Urol Int

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Background: microRNAs (miRs)-371-3 are suggested to be novel biomarkers of germ cell tumors (GCTs), but their specificity is unresolved. We aimed at clarifying the origin of miR 371a-3p by measuring this miR in peripheral vein blood, and in fluids present in the vicinity of GCTs. Methods: miR-371a-3p levels were measured by quantitative PCR in 9 tumor surrounding hydroceles and in cubital vein blood (CVB) and testicular vein blood (TVB) of 64 GCT patients, 51 with clinical stage (CS) 1, 13 with CS2-3. Thirty three CS1 cases had also postoperative CVB measurement. TVB miR levels were compared with those of CVB. Associations with clinical factors were analyzed statistically. Results: TVB miR levels were 294-fold, 80-fold and 4.6-fold higher than those in CVB of CS1 patients, CS2-3 patients and controls, respectively. Neoplastic hydrocele fluid comprised of very high miR levels. In CS1, miR levels dropped to normal postoperatively. Statistically, CVB miR levels are significantly associated with tumor size (p = 0.0211) and testis length (p = 0.0493). TVB miR levels are associated with testis length (p = 0.0129). Conclusions: This study provides evidence for the origin of circulating miR 371a-3p molecules from GCT cells. miR-371a-3p represents a specific serum biomarker for germ cell cancer.

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“…The patient subsequently underwent right orchiectomy and left neck dissection with evidence of complete pathological response. As the retroperitoneal lymphadenopathy had also resolved, resection of these sites was avoided consistent with professional society guidelines (15). …”

Section: Case Reportmentioning

confidence: 99%

Clinical Response of a Patient to Anti–PD-1 Immunotherapy and the Immune Landscape of Testicular Germ Cell Tumors

Shah

Ward

Bao

et al. 2016

Cancer Immunology Research

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Anti–Programed Death 1 (PD-1) is standard immunotherapy for multiple cancers and the expression of one of its ligands, PD-L1, has been described in germ cell tumors (GCTs). Neither the clinical activity of anti–PD-1 nor the incidence of an immunoresponsive tumor microenvironment has been described for GCTs. A patient initially diagnosed with melanoma via fine needle aspiration was treated with one dose of antibody to PD-1. A core needle biopsy was subsequently performed to acquire sufficient tissue for molecular analysis, which led to a change in diagnosis to metastatic embryonal carcinoma. The testicular GCT cohort of The Cancer Genome Atlas (TCGA) was analyzed using a T-cell gene signature associated with benefit from immunotherapy. Primary tumors (N = 134) were categorized as high (T cell–inflamed), medium, or low (non-T cell–inflamed) by their T-cell signature derived from RNAseq data. Anti-PD-1 induced decreases in serum markers and a 33% reduction in tumor volume. Gene expression revealed a T cell–inflamed tumor microenvironment in 47% of testicular GCTs, including seminoma (83%) and non-seminoma (17%) tumor subtypes. Expression of alpha-fetoprotein (AFP) RNA correlated with lack of the T-cell signature, with increasing AFP RNA inversely correlating with the inflamed signature and expression of interferon-γ–associated genes. These data suggest that GCTs can respond to anti–PD-1 and that gene expression profiling supports investigation of immunotherapy for treatment of GCTs.

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Testicular Cancer, Version 2.2015

Cited by 100 publications

References 39 publications

Pure Testicular Seminoma with Non-Pathologic Elevation of Alpha Fetoprotein: A Case Series

Pure Testicular Seminoma with Non-Pathologic Elevation of Alpha Fetoprotein: A Case Series

MicroRNA miR-371a-3p - A Novel Serum Biomarker of Testicular Germ Cell Tumors: Evidence for Specificity from Measurements in Testicular Vein Blood and in Neoplastic Hydrocele Fluid

Clinical Response of a Patient to Anti–PD-1 Immunotherapy and the Immune Landscape of Testicular Germ Cell Tumors

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