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Sixteen histologically documented testicular cancer specimens obtained at diagnostic procedures following induction chemotherapy with cis-platinum containing regimens were cloned in soft agar. Seven (44%) of the specimens cultured formed colonies with a mean cloning efficiency of .021%. Colony formation was observed with all the common histologic subtypes of testicular cancer (seminoma, embryonal carcinoma, choriocarcinoma and mixed tumors). In vitro drug sensitivity tests were performed using cis-platinum, vinblastine and VP-16. Three of four specimens demonstrated a decrease in colony formation to less than 50% of controls after a 1 h exposure to VP-16 at 300 micrograms/ml. Two of these patients had a response to treatment with a VP-16 based salvage regimen. Immunoperoxidase staining of the colonies for alpha feto protein and human chorionic gonadotropin were correlated with the serum levels of these tumor markers determined at the time the specimen was obtained. In three instances the same markers were elevated in the serum as detected within cells which formed the colonies; however, in two other cases the marker(s) that was elevated in the serum was not expressed in the colonies. In one case a biopsy of a residual retroperitoneal mass following chemotherapy histologically was a teratoma, but it formed colonies in the assay which stained positive for alpha feto protein. This patient subsequently developed an elevated serum alpha feto protein. These studies have demonstrated that (a) testicular cancer can be cloned directly in soft agar; (b) a heterogeneous tumor cell population exists in metastatic testicular cancer specimens; and (c) a dose response exists for VP-16 in relapsed testicular cancer which suggests that increasing the dose of VP-16 may be clinically beneficial.

In 1977 and 1978 the serum concentration of alpha-1-fetoprotein (AFP) in 3200 patients was measured for diagnostic purposes. Values above 320 ng/ml were observed in 75 patients; they underwent closer study. The final diagnoses were hepatoma (50), germ cell tumors (15), other malignant tumors (6) and acute hepatitis (4). Also, chronic hepatitis and liver coma may be associated with AFP values above 320 ng/ml. Repeated measurements usually provide further diagnostic information.

The cerebrospinal fluid (CSF) and plasma levels of CEA, AFP, alpha and beta hCG were determined by radioimmunoassay in 19 children with acute lymphoblastic leukaemia (ALL). CSF in 15 patients at the onset of ALL was examined in the first week after diagnosis and subsequently every two months. In 4 other children in second complete remission of ALL, CSF was examined every two months as well. Elevated values of CEACSF were present in 1/15 patients at the onset of ALL, of AFPCSF 0/15, alpha hCGCSF in 2/15, beta hCGCSF in 2/15 cases. The elevated levels of these markers in CSF became normal in successive lumbar punctures and none of these children developed central nervous system (CNS) relapse in further follow-up. Isolated CNS relapses were diagnosed 13 times in 7 children. Elevated CEACSF levels were found in 6/13 cases (maximum, 25.0 ng/ml) and in one patient CEACSF levels correlated well with pleocytosis. Elevated AFPCSF values were present in 0/13 cases, alpha hCGCSF in 0/13 and beta hCGCSF in 3/13 patients and became normal by the next CSF examination. The determination of CEA, AFP, alpha and beta hCG in plasma did not play a role in monitoring CNS relapse in ALL patients.