How would manage a patient with primary mediastinal NSGCT who has radiographic response but rising AFP while receiving VIP?

Patients with PMNSGCT are poor risk disease regardless of the size of the primary or amplitude of tumor markers hCG and AFP. For patients getting any cisplatin combination chemo, including testis primary, we always check tumor markers on day 1 of each course. In the patient in question, a rising marker during VIP indicates the patient is platinum-refractory. However, we consider ANY serum AFP < 25 as “ normal”. Thus a rise, e.g., from 10 ng/ml to 15 is not a rise indicating progression. If a clear and unequivocal rise, would recheck to make certain not a laboratory error. Sadly, if a true rise, the patient is almost certainly incurable. If disease is confined to the anterior mediastinum and potentially operable and resectable, that would be...