Intensive Induction Chemotherapy With CBOP/BEP in Patients With Poor Prognosis Germ Cell Tumors

2003 ◽  
Vol 21 (5) ◽  
pp. 871-877 ◽  
Author(s):  
J.A. Christian ◽  
R.A. Huddart ◽  
A. Norman ◽  
M. Mason ◽  
S. Fossa ◽  
...  
Keyword(s):  
Germ Cell ◽  
Induction Chemotherapy ◽  
Poor Prognosis ◽  
Germ Cell Tumors ◽  
Phase Iii ◽  
Royal Marsden Hospital ◽  
Prognosis Group ◽  
Male Patients ◽  
Patients With Poor Prognosis

Purpose: Despite a high cure rate in patients with testicular cancer, there remain patients in the poor prognosis group who have a less favorable outcome. Intensive induction chemotherapy using a regimen consisting of carboplatin, bleomycin, vincristine, and cisplatin, followed by bleomycin, etoposide, and cisplatin (CBOP/BEP), developed at the Royal Marsden Hospital, is designed to overcome the rapid proliferation seen in germ cell tumors. This study assesses the outcome of patients with poor-prognosis nonseminomatous germ cell tumors (NSGCT) treated with CBOP/BEP. Patients and Methods: Patients with NSGCT from three centers, classified as poor prognosis according to International Germ Cell Classification Consensus Group criteria, were treated with CBOP/BEP regimen during the period from 1989 to 2000. Data on treatment toxicity, relapse-free survival (RFS), and overall survival (OS) were collected prospectively on a hospital database. Results: Fifty-four male patients with poor prognosis NSGCT were treated with CBOP/BEP. The RFS at 3 and 5 years for all patients was 83.2% (95% confidence interval [CI], 68.8% to 91.3%). After a median follow-up of 4 years, the OS of the 54 patients was 91.5% (95% CI, 78.6% to 96.8%) at 3 years and 87.6% (95% CI, 71.3% to 94.9%) at 5 years. Three-year OS in patients with a primary mediastinal germ cell tumor was 77.1% (95% CI, 34.5% to 93.9%) compared with 95.4% (95% CI, 82.8% to 98.8%) in patients with a testicular primary tumor (P = .24). Conclusion: The results reported here compare favorably with the historical results of alternative regimens used in the management of poor-prognosis NSGCT. We suggest a phase III trial to confirm our findings.

Determination of efficacy of TIP combination (paclitaxel, ifosfamide, cisplatin) as first salvage therapy for patients with relapsed germ cell tumors in a poor prognosis group

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16049-e16049
Author(s):  
J. Mardiak ◽  
K. Rejlekova ◽  
M. Mego ◽  
J. Rajec ◽  
Z. Sycova-Mila ◽  
...  
Keyword(s):  
Germ Cell ◽  
Salvage Therapy ◽  
Poor Prognosis ◽  
Chemotherapy Regimen ◽  
Germ Cell Tumors ◽  
Complete Response ◽  
Good Prognosis ◽  
Prognostic Features ◽  
Patients With Poor Prognosis

e16049 Background: The efficacy of TIP appears to be suitable salvage therapy for patients with relapsed germ cell tumors (GCTs) with good prognostic features.The aim of our study was to determine the efficacy of TIP as first salvage therapy for patients with relapsed GCTs with poor prognostic features. Methods: Thirty seven patients with relapsed GCTs were treated with TIP as first salvage therapy. Sixteen (43%) patients had favorable prognostic features for response (testis primary tumor site and prior complete response to induction chemotherapy regimen) and 21 (57%) patients had poor prognostic features (either extragonadal site or incomplete response to induction chemotherapy regimen). Four cycles of paclitaxel (175 to 250 mg/m2), ifosfamide 6 g/m2, and cisplatin 100 mg/m2 were given 21 days apart with GC-SF support, followed by resection of resectable radiographic residua. Results: Ten (69%) out of 16 patients with good prognostic features achieved a favorable response to TIP, and all 10 (100%) patients achieved complete response (CR). Six (60%) of the favorable responses remain durable at a median follow-up of 50,6 months. 9 (43%) of 21 patients with poor prognosis achieved a favorable response to chemotherapy, from whom only 1 (10%) patient achieved CR, but 5 patients achieved durable response at a median follow-up duration of 60,6 months. Estimated 2-year overall survival rate (OS) for patients with good prognosis was 56% (95 % CI 54–100%) and 33% (95% CI 21–68%) for patients with poor prognosis. Despite this results, estimated 5-year OS was even more positive for patients with poor prognosis 19% (95% CI 15–61%) comparing to 13% (95% CI 23–80%) for patients with good prognosis. Conclusions: Demonstrated long-term survival of patients with poor prognosis in our nonrandomised study with limited number of patients refers to the TIP being suitable therapy also for patients with relapsed GCTs with poor prognosis. These results warrant the need to continue investigation of real effectiveness of TIP as a first salvage therapy even for patients with poor prognostic features. No significant financial relationships to disclose.

Treatment outcomes of patients (pts) with primary mediastinal germ cell tumors (PMGCT): The M. D. Anderson Cancer Center (MDACC) experience

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14538-14538
Author(s):  
A. J. Rodney ◽  
A. Siefker-Radtke ◽  
N. M. Tannir ◽  
S. Swisher ◽  
G. Walsh ◽  
...  
Keyword(s):  
Germ Cell ◽  
Poor Prognosis ◽  
Lung Metastases ◽  
Germ Cell Tumors ◽  
Phase Iii ◽  
Term Survival ◽  
Excellent Outcome ◽  
Undifferentiated Histology ◽  
Disease Free

14538 Background: PMGCT are uncommon germ cell malignancies. Mediastinal nonseminomatous germ cell tumors (NSGCT) have a poor prognosis, whereas pure seminoma (Sem) has a good or intermediate prognosis irrespective of mediastinal presentation. Methods: We retrospectively identified 19 male pts with PMGCT seen at MDACC between October 1998 and September 2004 from a clinical database. Pts with resectable NSGCT were offered surgery upon plateau of their chemotherapy response. Prior to referral, 1 pt had primary surgical resection without preoperative (preop) chemotherapy. Results: There were 14 pts with NSGCT and 5 with good prognosis Sem. The median age was 29.5 (20–60). Seven pts with NSGCT had mixed or undifferentiated histology, and the remainder had pure yolk sac (5 pts) or choriocarcinoma (2 pts). The estimated median survival (Kaplan-Meier) for all patients (Sem + NSGCT) was 21 months. All pts with Sem were alive and disease-free at last follow-up (median 12 months, range 7–34). All pts with Sem received 4 courses of etoposide and cisplatin (EP); one also received bleomycin (BEP); one received radiotherapy consolidation; none received surgery. Of the pts with NSGCT, 9 (64%) have died, including 1 who refused surgery. Five pts with NSGCT were alive at last follow-up and 3 (21%) were disease-free (15+, 27+ and 35+ months). Four pts with NSGCT (29%) reached beyond 2 years survival (27+, 28, 35+, and 63+ months) including 3 with lung metastases and one with elevated preop alpha-fetoprotein (28,022 ng/ml). Each of these pts received 6–10 courses of multiple-regimen preop chemotherapy, and 2 received initially 4 courses of BEP without marker normalization. Conclusions: Mediastinal Sem treated with 4 courses EP had an excellent outcome without surgery. Pts with mediastinal NSGCT had a 64% mortality rate despite aggressive treatment. Several pts with mediastinal NSGCT did achieve long-term survival following aggressive chemotherapy and surgery, even with lung metastases and failure to normalize markers. A phase III trial of BEP versus dose-dense chemotherapy for poor-prognosis NSGCT is now in progress at MDACC. No significant financial relationships to disclose.

Impact of extrascrotal symptoms on treatment outcome in patients with nonseminomatous germ cell tumor with intermediate or poor prognosis.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 384-384
Author(s):  
Shigeyuki Yamada ◽  
Hideo Saito ◽  
Koji Mitsuzuka ◽  
Akihiro Ito ◽  
Yoichi Arai
Keyword(s):  
Germ Cell ◽  
Induction Chemotherapy ◽  
Poor Prognosis ◽  
Proportional Hazards Model ◽  
Germ Cell Tumors ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
University Hospital ◽  
Significant Difference ◽  
Prognosis Group

384 Background: The International Germ Cell Consensus (IGCC) classification is based on primary tumor localization, presence of non-pulmonary visceral metastases, and serum tumor marker levels, not the general condition of patients. The present study aimed to identify novel prognostic factors for nonseminomatous germ cell tumors (NSGCTs) with IGCC intermediate or poor prognosis. Methods: We retrospectively analyzed 399 patients with germ cell tumors (GCT) treated at Tohoku University Hospital between 1979 and 2011. Of these, 52 and 61 patients with NSGCTs were classified as having intermediate and poor prognosis, respectively. Several clinical parameters were reviewed, including age, IGCC prognosis group, kind of induction chemotherapy, and extra-scrotal symptoms at presentation. Extra-scrotal symptoms were defined as symptoms other than scrotal swelling, such as abdominal pain, lumbago, and dyspnea. Survival was estimated using the Kaplan-Meier method. A Cox proportional hazards model was used to assess potential predictors of outcome. Results: The median age of the 113 patients was 30. Median length of follow-up was 57 months. At presentation, 12 (23%) patients with intermediate prognosis and 32 (52%) patients with poor prognosis had extra-scrotal symptoms. In the intermediate prognosis group, the five year overall survival (OS) of patients with extra-scrotal symptoms was significantly worse than that of patients without symptoms (95% vs. 63%, p= 0.0008), but there was no significant difference in five year OS between patients with and without extra-scrotal symptoms in the poor prognosis group (60% vs. 66%, p= 0.265). On multivariate analysis, the presence of extra-scrotal symptoms (hazard ratio [HR] = 2.48, p= 0.0184) and induction chemotherapy not including etoposide (HR = 12.0, p< 0.0001) were independent predictors of inferior OS. Conclusions: The presence of extra-scrotal symptoms was associated with inferior OS, particularly in patients with intermediate prognosis. Intermediate-prognosis patients with extra-scrotal symptoms should be recognized as having poor prognosis.

Retrospective comparison of treatment outcome and cost effective analysis of BEP and VIP for poor-prognosis metastatic germ cell tumors in India

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14638-14638
Author(s):  
H. K. Dadhich ◽  
S. V. Attili ◽  
K. S. Saini ◽  
U. Batra ◽  
L. A. Jacob ◽  
...  
Keyword(s):  
Germ Cell ◽  
Poor Prognosis ◽  
Germ Cell Tumors ◽  
Cost Effective ◽  
Serum Markers ◽  
Retrospective Comparison ◽  
Male Patients ◽  
Indian Setting ◽  
Effective Analysis

14638 Purpose: Retrospective comparison of treatment out come and cost effective analysis in two chemotherapeutic regimens (BEP vs. VIP) for poor-prognosis metastatic germ cell tumors in India, a resource poor nation. Methods: All male patients with poor risk germ cell tumors were included in the study between 2001–2003. The patients were stratified into two categories depending on the type of the regimens they received. Results: Finally 36 patients were analyzed with median follow up of 21.8 months. Medical 7.5 for windows was used for the analysis. The baseline characters (age, stage, PS, histology and serum markers) were not different in two treatment arms (P > 0.05). The different treatments (BEP vs. VIP) had no statistically significant influence on the outcome. VIP is less cost effective and more toxic compared to BEP. Conclusion: In view of absence of survival advantage and more toxicities as well as cost of therapy it would be appropriate to still treat the patients of high risk germ cell tumors with the conventional BEP rather than VIP in the Indian setting and keeping the later reserved for the relapse. [Table: see text] No significant financial relationships to disclose.

Spermatocytic Tumor With Sarcoma: A Rare Testicular Neoplasm

2017 ◽  
Vol 25 (6) ◽  
pp. 559-562 ◽  
Author(s):  
Ashley E. Stueck ◽  
John E. Grantmyre ◽  
Lori A. Wood ◽  
Cheng Wang ◽  
Jennifer Merrimen
Keyword(s):  
Differential Diagnosis ◽  
Germ Cell ◽  
Poor Prognosis ◽  
Germ Cell Tumors ◽  
Testicular Neoplasm ◽  
Spermatocytic Seminoma ◽  
Isochromosome 12P ◽  
Pathologic Findings

Spermatocytic tumor, formerly known as spermatocytic seminoma, is an uncommon testicular neoplasm which is a distinct clinicopathologic entity from classic seminoma. These tumors are not associated with germ cell neoplasia in situ, other germ cell tumors, or isochromosome 12p. Although typically, these tumors have an excellent prognosis occasional cases are associated with sarcoma and have a very poor prognosis. We present a case of spermatocytic tumor with sarcoma showing a chondrosarcomatous component, discuss the pathologic findings and differential diagnosis and provide follow-up information.

Randomized trial of etoposide and cisplatin versus etoposide and carboplatin in patients with good-risk germ cell tumors: a multiinstitutional study.

1993 ◽  
Vol 11 (4) ◽  
pp. 598-606 ◽  
Author(s):  
D F Bajorin ◽  
M F Sarosdy ◽  
D G Pfister ◽  
M Mazumdar ◽  
R J Motzer ◽  
...  
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumors ◽  
Complete Response ◽  
Phase Iii ◽  
Relapse Free Survival ◽  
Free Survival ◽  
To Receive ◽  
Carboplatin Dose ◽  
Good Risk

PURPOSE This multicenter, randomized phase III clinical trial evaluated the efficacy of etoposide plus carboplatin (EC) versus etoposide plus cisplatin (EP) in good-risk germ cell tumor (GCT) patients. PATIENTS AND METHODS Between October 1986 and December 1990, 270 patients with good-risk GCTs were randomized to receive four cycles of either EP or EC. The etoposide dose in all patients was 100 mg/m2 on days 1 through 5. EP patients received cisplatin at 20 mg/m2 on days 1 through 5 and therapy was recycled at 21-day intervals. For EC patients, the carboplatin dose was 500 mg/m2 on day 1 of each cycle and the EC recycling interval was 28 days. RESULTS Two hundred sixty-five patients were assessable: 131 patients treated with EC and 134 treated with EP. One hundred fifteen of 131 assessable patients (88%) treated with EC achieved a complete response (CR) versus 121 of 134 patients (90%) treated with EP (P = .32). Sixteen patients (12%) treated with EC relapsed from CR versus four patients (3%) treated with EP. Therefore, 32 patients (24%) who received carboplatin experienced an event (incomplete response [IR] or relapse) compared with 17 of 134 patients (13%) who received cisplatin (P = .02). At a median follow-up of 22.4 months, event-free and relapse-free survival were inferior for patients treated with EC (P = .02 and P = .005, respectively). No difference in overall survival was evident (P = .52). CONCLUSION Two-drug therapy with EC using this dose and schedule was inferior to therapy with EP. Cisplatin remains as the standard platinum analog in the treatment of patients with good-risk GCTs. Carboplatin should be restricted to investigational trials in GCT.

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