hCG and LDH concentrations above the normal range can occur with any germ cell tumor histology
June 11, 2010 (Chicago, Illinois) — The American Society of Clinical Oncology (ASCO) has issued a guideline on the use of serum tumor markers in the diagnosis, treatment, and management of germ cell tumors in men, which include, most commonly, testicular cancer.
The germ cell tumors clinical practice guideline was announced at a press conference here at the organization's 2010 Annual Meeting.
This is the newest guideline on the use of biomarkers for specific cancers from ASCO — with more to come as part of an "expanded series" of guidelines on biomarkers.
The initial 2 guidelines on biomarkers were on breast (2007) and gastrointestinal cancers (2006).
Why has ASCO chosen germ cell tumors, which are rare — with fewer than 9000 cases annually in the United States — for their third tumor marker guideline?
According to the panel of authors of the guideline, which was published online June 7 in the Journal of Clinical Oncology, it is "because of the large volume of publications and the long history of using serum concentrations of human chorionic gonadotropin (hCG), alpha-fetoprotein (AFP), and lactate dehydrogenase (LDH) to guide management decisions for patients with GCT."
In short, there is clinical value in using biomarkers to help manage patients with germ cell tumors, the authors explain
At the press conference, the new guideline's lead author, Timothy D. Gilligan, MD, from the Cleveland Clinic in Ohio, said that these 3 biomarkers for germ cell tumors "play a critical role in the management of these tumors."
He also hinted that some tumor markers might not be as clinically useful as the germ cell tumor markers.
Medical tests that measure tumor biomarkers are not as rigorously examined by the US Food and Drug Administration (FDA) as drugs are, he explained.
"The FDA doesn't require that marker products improve outcome. The products are only required to measure what they claim to measure," he told reporters at the press conference.
He called for "better evidence about whether tumor markers for other cancers help provide better care for patients." Specifically, he called for proof that the tumor-marker products "improve medical outcomes or quality of life."
The stakes can be high when patients undergo biomarker tests, Dr. Gilligan noted.
"Medical tests are dangerous," he said. "They can lead to a waterfall of further tests and unnecessary treatment."
Dr. Gilligan cited the use of prostate-specific antigen (PSA) as a screening test for prostate cancer as an example of a problematic biomarker that has produced overdiagnosis and overtreatment of disease. The introduction of the PSA screening test in the mid-1980s led to an estimated 1 million cases of overdiagnosis of prostate cancer by 2009, as reported by Medscape Oncology.
Dr. Gilligan called for improved tests to detect cancer. "We need better tests to detect treatable cancers earlier so that treatment will be more effective."
The future of tumor biomarkers promises to be busy, suggested Dr. Gilligan. "This is a big area of research. There are a lot of new products coming out along these lines," he said.
What's New in Germ Cell Tumor Markers
The expert panel convened by ASCO, which included Dr. Gilligan, conducted a systematic review of medical research literature, in partnership with Cancer Care Ontario, to develop the new recommendations on germ cell tumors and related serum tumor markers.
Germ cell tumors might be rare but they are also among the most curable cancers, with more than 90% of men cured, according to Dr. Gilligan. Germ cell tumors most commonly start in sperm-producing cells in the testicles. Testicular cancers are typically detected when the patient notices a swelling or irregularity in the shower or when dressing, Dr. Gilligan explained.
"Testicular cancer is curable in most cases, but proper management is key because the stakes are high, both for survival and quality of life," said Dr. Gilligan in a press statement.
AFP, hCG, and LDH should not be used to screen for germ cell tumors, to help decide whether orchiectomy is needed, or to make treatment decisions for patients with cancer of unknown origin, notes the guideline.
This news about the latter practice — using germ cell tumor markers to choose a chemotherapy regimen for patients with a cancer of unknown primary — is worth highlighting, noted Dr. Gilligan "This has been the practice, but the literature does not support use of tumor markers for this," he said.
The other most notable new recommendation, said Dr. Gilligan, is about serum tumor markers: they should not be used as part of "surveillance for stage I seminomas."
The diagnosis of germ cell tumors in men is divided into 2 different types — seminoma and nonseminoma, said Dr. Gilligan.
Generally, seminomas are relatively slow-growing; nonseminomas tend to grow and spread more quickly and are treated differently.
Seminoma cells do not produce AFP. As a result, concentrations above the normal range of AFP can occur in patients with nonseminomas but not in those with pure seminoma. In contrast, hCG and LDH concentrations above the normal range can occur with any germ cell tumor histology, write the authors of the new guideline.
A rise in these markers generally indicates disease relapse in patients who have been treated, said Dr. Gilligan.
However, as noted above, Dr. Gilligan and his colleagues recommend against using these markers as part of surveillance in stage I seminomas.
Dr. Gilligan has disclosed no relevant financial relationships.
J Clin Oncol. Published online June 7, 2010. Abstract
Showing posts with label human hcg. Show all posts
Showing posts with label human hcg. Show all posts
Wednesday
HCG, popular among steroid users, has other uses
By RACHEL COHEN AP Sports Writer
The banned substance linked to Manny Ramirez is commonly taken by steroid users but also can be prescribed for other conditions.
A person familiar with the details of the suspension said Ramirez provided a urine sample during spring training that tested positive for HCG, Human Chorionic Gonadotropin . The person spoke to The Associated Press on condition of anonymity because the banned substance wasn’t announced.
HCG, added to baseball’s banned substances list last year, is popular among users of performance-enhancing drugs because it can mitigate the side effects of ending a cycle of steroids. The body may stop producing testosterone when a user goes off steroids, which can cause sperm counts to decrease and testicles to shrink.
“They use Human Chorionic Gonadotropin (HCG) to essentially jump start testosterone production,” said Ruth Wood, an expert in steroid abuse at the University of Southern California.
The drug could have appropriate uses unconnected to steroid abuse, said Dr. Gary Wadler, who leads the committee that determines the banned-substances list for the World Anti-Doping Agency. HCG can treat male infertility and testosterone deficiency, he said.
“It’s not necessarily the drug of choice, but those are acceptable uses,” Wadler said.
Ramirez said in a statement he did not take steroids but that a doctor gave him medication for “a personal health issue.”
Every baseball player is tested each year within five days of reporting to spring training and again at a randomly selected unannounced date. There are 1,200 additional unannounced tests of randomly selected players, including up to 375 during the offseasons from 2008 through the start of spring training in 2011.
“We have no knowledge of the Ramirez case, but it’s highly unlikely an otherwise healthy, young athlete would need Human Chorionic Gonadotropin for a legitimate medical reason,” said U.S. Anti-Doping Agency CEO Travis Tygart. “That said, if there was valid medical need, his high-priced representatives should be fired for not ensuring that he was informed of the process that could have granted him permission to use it.”
Athletes in the BALCO scandal have been linked to the female fertility drug Clomid.
Side effects of Human Chorionic Gonadotropin include headache, mood swings and depression, Wadler said. The anti-doping community has been familiar with HCG for more than 20 years, he added.
HCG is prescribed to treat infertility in women by triggering ovulation. The hormone naturally occurs in pregnant women – home pregnancy kits test for one portion of the HCG molecule, Wood said.
AP Baseball Writer Ron Blum in New York and National Writer Eddie Pells in Colorado Springs, Colo., contributed to this report.
The banned substance linked to Manny Ramirez is commonly taken by steroid users but also can be prescribed for other conditions.
A person familiar with the details of the suspension said Ramirez provided a urine sample during spring training that tested positive for HCG, Human Chorionic Gonadotropin . The person spoke to The Associated Press on condition of anonymity because the banned substance wasn’t announced.
HCG, added to baseball’s banned substances list last year, is popular among users of performance-enhancing drugs because it can mitigate the side effects of ending a cycle of steroids. The body may stop producing testosterone when a user goes off steroids, which can cause sperm counts to decrease and testicles to shrink.
“They use Human Chorionic Gonadotropin (HCG) to essentially jump start testosterone production,” said Ruth Wood, an expert in steroid abuse at the University of Southern California.
The drug could have appropriate uses unconnected to steroid abuse, said Dr. Gary Wadler, who leads the committee that determines the banned-substances list for the World Anti-Doping Agency. HCG can treat male infertility and testosterone deficiency, he said.
“It’s not necessarily the drug of choice, but those are acceptable uses,” Wadler said.
Ramirez said in a statement he did not take steroids but that a doctor gave him medication for “a personal health issue.”
Every baseball player is tested each year within five days of reporting to spring training and again at a randomly selected unannounced date. There are 1,200 additional unannounced tests of randomly selected players, including up to 375 during the offseasons from 2008 through the start of spring training in 2011.
“We have no knowledge of the Ramirez case, but it’s highly unlikely an otherwise healthy, young athlete would need Human Chorionic Gonadotropin for a legitimate medical reason,” said U.S. Anti-Doping Agency CEO Travis Tygart. “That said, if there was valid medical need, his high-priced representatives should be fired for not ensuring that he was informed of the process that could have granted him permission to use it.”
Athletes in the BALCO scandal have been linked to the female fertility drug Clomid.
Side effects of Human Chorionic Gonadotropin include headache, mood swings and depression, Wadler said. The anti-doping community has been familiar with HCG for more than 20 years, he added.
HCG is prescribed to treat infertility in women by triggering ovulation. The hormone naturally occurs in pregnant women – home pregnancy kits test for one portion of the HCG molecule, Wood said.
AP Baseball Writer Ron Blum in New York and National Writer Eddie Pells in Colorado Springs, Colo., contributed to this report.
Why is HCG Used as a Performance Enhancing Drug
In the world of performance enhancing drugs, Human Chorionic Gonadotropin hCG is increasingly used in combination with various anabolic androgenic steroid (AAS) cycles. As a result, hCG is included in some sports' illegal drug lists.
When AAS are put into a male body, the body's natural negative-feedback loops cause the body to shut down its own production of testosterone via shutdown of the hypothalamic-pituitary-gonadal axis (HPGA). This causes testicular atrophy, among other things. Human Chorionic Gonadotropin HCG is commonly used during and after steroid cycles to maintain and restore testicular size as well as normal testosterone production.
High levels of AASs that mimic the body's natural testosterone trigger the hypothalamus to shut down its production of gonadotropin-releasing hormone (GnRH) from the hypothalamus. Without GnRH, the pituitary gland stops releasing luteinizing hormone (LH). LH normally travels from the pituitary via the blood stream to the testes, where it triggers the production and release of testosterone. Without LH, the testes shut down their production of testosterone. In males, Human Chorionic Gonadotropin helps restore and maintain testosterone production in the testes by mimicking LH and triggering the production and release of testosterone.
If HCG is used for too long and in too high a dose, the resulting rise in natural testosterone will eventually inhibit its own production via negative feedback on the hypothalamus and pituitary.
.
When AAS are put into a male body, the body's natural negative-feedback loops cause the body to shut down its own production of testosterone via shutdown of the hypothalamic-pituitary-gonadal axis (HPGA). This causes testicular atrophy, among other things. Human Chorionic Gonadotropin HCG is commonly used during and after steroid cycles to maintain and restore testicular size as well as normal testosterone production.
High levels of AASs that mimic the body's natural testosterone trigger the hypothalamus to shut down its production of gonadotropin-releasing hormone (GnRH) from the hypothalamus. Without GnRH, the pituitary gland stops releasing luteinizing hormone (LH). LH normally travels from the pituitary via the blood stream to the testes, where it triggers the production and release of testosterone. Without LH, the testes shut down their production of testosterone. In males, Human Chorionic Gonadotropin helps restore and maintain testosterone production in the testes by mimicking LH and triggering the production and release of testosterone.
If HCG is used for too long and in too high a dose, the resulting rise in natural testosterone will eventually inhibit its own production via negative feedback on the hypothalamus and pituitary.
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