Etoposide and Cisplatin Chemotherapy for Metastatic Good-Risk Germ Cell Tumors

2005 ◽  
Vol 23 (36) ◽  
pp. 9290-9294 ◽  
Author(s):  
G. Varuni Kondagunta ◽  
Jennifer Bacik ◽  
Dean Bajorin ◽  
Deborah Dobrzynski ◽  
Joel Sheinfeld ◽  
...  
Keyword(s):  
Germ Cell ◽  
Residual Disease ◽  
Mature Teratoma ◽  
Germ Cell Tumors ◽  
Complete Response ◽  
Late Relapse ◽  
Standard Regimen ◽  
Consensus Classification ◽  
Good Risk

Purpose To assess response, overall survival, and relapse-free survival of patients with good-risk metastatic germ cell tumor (GCT) by International Germ Cell Consensus Classification Group (IGCCCG) criteria treated with four cycles of etoposide and cisplatin (EP). Patients and Methods Two hundred eighty-nine patients with IGCCCG good-risk GCT were treated with four cycles of EP. EP consisted of four cycles of etoposide 100 mg/m2 and cisplatin 20 mg/m2 on days 1 to 5 every 21 days. Results Two hundred eighty-two of 289 patients (98%) achieved a complete response; 269 (93%) responded to chemotherapy alone and 13 (5%) responded to chemotherapy plus surgical resection of viable disease (GCT other than mature teratoma). Seventeen (6%) experienced relapse, and nine (3%) died as a result of disease at a median follow-up of 7.7 years (range, 0.4 to 21.1 years). Sixty-two of 204 patients (30%) with nonseminoma had findings of teratoma or viable GCT at postchemotherapy surgery. Conclusion Four cycles of EP is a highly effective therapy for patients with good-risk GCT, with a high cure rate, low relapse rate, and little evidence of late relapse. Postchemotherapy surgery resection of residual disease remains an important aspect of treatment for these patients. Four cycles of EP is acceptable as a standard regimen for the treatment of good-risk metastatic GCT, and serves as an alternative to three cycles of bleomycin and etoposide before cisplatin.

Late relapse of testicular cancer.

1983 ◽  
Vol 1 (9) ◽  
pp. 566-571 ◽  
Author(s):  
H R Terebelo ◽  
H G Taylor ◽  
A Brown ◽  
N Martin ◽  
F H Stutz ◽  
...  
Keyword(s):  
Testicular Cancer ◽  
Germ Cell ◽  
Salvage Therapy ◽  
Residual Disease ◽  
Germ Cell Tumors ◽  
Complete Response ◽  
Late Relapse ◽  
First Year ◽  
Do So

The complete response (CR) rate of disseminated germ-cell tumors with current aggressive chemotherapy and surgical resection of localized residual disease is between 70%-80%. Most patients who relapse do so within the first year of therapy. We have observed seven patients with germ-cell tumors treated with a variety of modalities who relapsed after more than two years in CR (45-87 months). Five patients are alive after salvage therapy with follow-up too short to assess the durability of second remission. There were no features distinguishing late relapse patients from all patients treated with chemotherapy for germ-cell tumors. Follow-up in patients treated for germ-cell tumors with chemotherapy should be extended to five years before curability can be established.

Long-term follow-up of patients with good-risk germ cell tumors treated with etoposide and cisplatin.

1997 ◽  
Vol 15 (7) ◽  
pp. 2553-2558 ◽  
Author(s):  
H Xiao ◽  
M Mazumdar ◽  
D F Bajorin ◽  
M Sarosdy ◽  
V Vlamis ◽  
...  
Keyword(s):  
Germ Cell ◽  
Salvage Therapy ◽  
Germ Cell Tumors ◽  
Complete Response ◽  
Response To Therapy ◽  
Survival Status ◽  
Long Term Follow Up ◽  
Time To Relapse ◽  
Good Risk

PURPOSE To assess the durability of response and overall survival for patients with good-risk metastatic germ cell tumors (GCT) treated with four cycles of etoposide and cisplatin (EP). PATIENTS AND METHODS Two hundred fourteen patients treated with EP on two consecutive randomized trials for good-risk metastatic GCT were the subject of this retrospective study. The response to therapy, relapse and survival status, and results of salvage therapy are reported. RESULTS One hundred ninety-five patients (91%) achieved a complete response (CR). This included 182 patients (85%) who achieved a CR to chemotherapy alone and 13 patients (6%) who achieved a CR to chemotherapy plus surgical resection of viable GCT. Seventeen patients (9%) have relapsed from CR. The median time to relapse was 10 months, and the longest duration from treatment to relapse was 36 months in a patient who received three of four planned courses of therapy. Eight patients who either achieved an incomplete response (IR) or relapsed were rendered continuously disease-free by salvage therapy and are alive. One hundred eighty-three patients (86%) are alive at a median follow-up of 7.6 years. CONCLUSION Four cycles of EP constitute effective therapy and can be offered to patients with good-risk GCT. In patients with intermediate- and poor-risk GCT, clinical trials remain a priority to identify more effective treatment.

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.

Pregnancy following surgery and chemotherapy for ovarian germ cell tumors.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16550-e16550
Author(s):  
Karen Murphy ◽  
Scheryll Paula Alken ◽  
John McCaffrey ◽  
Desmond Carney ◽  
Miriam O Connor
Keyword(s):  
Germ Cell ◽  
Young Women ◽  
Residual Disease ◽  
Mature Teratoma ◽  
Germ Cell Tumour ◽  
Germ Cell Tumors ◽  
Germ Cell Tumours ◽  
Platinum Based Chemotherapy ◽  
Clinical Records

e16550 Background: Malignant ovarian germ cell tumours(OGCT) are a rare disease, accounting for 2% of all malignant ovarian tumours diagnosed in Ireland between 1994 - 2010. They affect a younger population than epithelial ovarian cancer, with the highest number of cases in the second and third decade. In this report, we present a review of patients treated in a tertiary referral centre. Methods: We performed a retrospective review over a 26 year period in our institution. We examined clinical records, pathology, pharmacy and surgical databases to identify patients with ovarian germ cell tumours who were treated in our institution. Results: During the period 1986 – 2012, twenty patients were treated and followed at this institution for malignant ovarian germ cell tumor (OGCT). Eighteen patients are alive and well at a median follow up of 14.5 years (range 0.5 – 26). Nineteen patients received platinum based chemotherapy with a median number of four cycles (range 2 – 6) required to achieve complete remission. Twenty percent of patients had yolk sac histology; the next commonest were immature teratomas and mixed germ cell tumour (10 & 15% respectively). The commonest chemotherapy regimen used was BEP (bleomyocin, etoposide and cistplatin). Six patients (30%) underwent resection of residual disease post chemo revealing mature teratoma/necrotic tissue. During follow up, four patients had progressive or recurrent disease. Two patients at resection had mature teratomas found on histological examination. The remaining two patients (10%) had progressive disease and died within a short time period. In our patient population, nine of nine attempting pregnancy have been successful. There have been 12 pregnancies carried to term; mother and child in each case are well. At a median follow up of 14.5 years (range 0.5 – 26), there have been no second malignancies and no toxicities attributable to chemotherapy. Conclusions: We have shown that platinum based chemo in OGCT is associated with preservation of fertility in these young women. In our series there have been no adverse affects in women or their infants. Platinum based chemo highly successful in curing OGCT and this confirms that it is associated with preserved fertility in these young women.

Post-chemotherapy modified template retroperitoneal lymph node dissection in patients with nonseminomatous germ cell tumours

2021 ◽  
Author(s):  
Murat Zor ◽  
Sercan Yilmaz ◽  
Bahadir Topuz ◽  
Engin Kaya ◽  
Serdar Yalcin ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Germ Cell ◽  
Residual Disease ◽  
Germ Cell Tumors ◽  
Operation Time ◽  
Long Term Results ◽  
Perioperative Outcomes ◽  
Retroperitoneal Lymph Node Dissection

Abstract Introduction/background: Although a full bilateral template RPLND is thought to be the standard of care for the management of postchemotherapy retroperitoneal residual masses for nonseminomatous germ cell tumors (NSGCT), in the past decade modified templates have become increasingly popular. In this study, we aimed to present our oncological and perioperative outcomes of consecutive seventeen NSGCT patients who underwent a modified template unilateral PC-RPLND for retroperitoneal residual disease. Materials and Methods: We retrospectively evaluated the medical records of 17 consecutive NSGCT patients who underwent modified template unilateral PC-RPLND in our university hospital between 2017 and 2020. All patients had normal serum tumour markers with residual disease in the retroperitoneum. Surgical characteristics including the size of the retroperitoneal residual mass, residual tumor pathology, removed lymph nodes, positive percentage of removed lymph nodes, accompanying operations, complications, mean operation time and hospital stay, and long-term results including survival and antegrade ejaculation were evaluated. Results: Eleven patients underwent left and six right-sided surgery. Median residual lymph node diameter was 41mm. Median hospitalisation time was 3.5 days. Median follow-up time was 10.5 months. Necrosis/fibrosis was seen in 6 patients, and teratoma in 11 patients. No viable tumour was seen. No patients died in the follow-up period. None of the patients relapsed during follow-up. Ten/seventeen patients had antegrade ejaculation. Conclusions: Modified template unilateral PC-RPLND leads to very good oncological outcomes with decreased perioperative morbidity as well as better antegrade ejaculation rates. Low volume retroperitoneal disease seems to fit this procedure best.

High-dose carboplatin, etoposide, and cyclophosphamide for patients with refractory germ cell tumors: treatment results and prognostic factors for survival and toxicity.

1996 ◽  
Vol 14 (4) ◽  
pp. 1098-1105 ◽  
Author(s):  
R J Motzer ◽  
M Mazumdar ◽  
G J Bosl ◽  
D F Bajorin ◽  
A Amsterdam ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Germ Cell ◽  
Autologous Bone Marrow Transplantation ◽  
Prospective Trial ◽  
Germ Cell Tumors ◽  
Complete Response ◽  
High Dose ◽  
Dismal Prognosis ◽  
Count Recovery

PURPOSE The efficacy and toxicity of high-dose carboplatin, etoposide, and cyclophosphamide with autologous bone marrow transplantation (AuBMT) was investigated in a prospective trial for patients with cisplatin-refractory germ cell tumor (GCT). Prognostic factors for survival and treatment-related toxicity were identified. PATIENTS AND METHODS Fifty-eight patients with refractory GCT were treated with high-dose carboplatin, etoposide, and cyclophosphamide plus AuBMT. Prognostic factors for toxicity and survival were examined in multivariate analyses. RESULTS Twenty-three patients (40%) achieved a complete response and 12 (21%) are alive and free of disease at a median follow-up time of 28 months. Myelosuppression was severe and there were seven (12%) treatment-related deaths. Independently predictive factors that resulted in faster blood count recovery were the use of granulocyte colony-stimulating factor (G-CSF) for the number of days to neutrophil count recovery (P = .013) and prior treatment with cisplatin limited to six cycles or less for the number of days to platelet count recovery (P = .0012). Both were predictive for the number of days of hospitalization (P = .04 and .03, respectively). The two independently predictive variables for survival were pretreatment level of HCG; human chorionic gonadotrophin (HCG; < or = 100 times the upper limit of normal [xnl] v > 100 xnl, P = .02) and the presence of retroperitoneal metastases (yes or no, P = .04). Patients grouped by HCG < or = 100 xnl with retroperitoneal metastases, HCG < or = 100 xnl without retroperitoneal metastases, and all patients with HCG more than 100 xnl had median survival times of 14, 11, and 3 months, respectively (P = .04). CONCLUSION High-dose carboplatin, etoposide, and cyclophosphamide is an effective therapy for patients with refractory GCT, and results in a complete response proportion of 40% and a 2-year survival rate of 31% at a median follow-up time of 28 months. This was accomplished in a group of patients with a dismal prognosis to conventional-dose therapy.

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.

Interim results of phase II trial of the cyclin-dependent kinase 4/6 inhibitor PD-0332991 in refractory retinoblastoma protein positive germ cell tumors.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 4596-4596 ◽  
Author(s):  
David J. Vaughn ◽  
Maryann Gallagher ◽  
Priti Lal ◽  
Mark Alan Rosen ◽  
Wei-Ting Hwang ◽  
...  
Keyword(s):  
Germ Cell ◽  
Phase Ii ◽  
Phase Ii Trial ◽  
Mature Teratoma ◽  
Germ Cell Tumors ◽  
Retinoblastoma Protein ◽  
Predictive Biomarkers ◽  
Median Number ◽  
Late Relapse ◽  
Cyclin Dependent Kinase

4596 Background: Deregulation of the retinoblastoma pathway in germ cell tumors (GCT) has been well documented. We previously reported that PD-0332991, a selective oral inhibitor of cyclin-dependent kinase 4/6, led to prolonged disease control in 3 patients (pts) with unresectable growing teratoma syndrome (NEJM, 2009). For these reasons, we initiated a phase II trial of PD-0332991 in pts with refractory retinoblastoma protein (Rb) positive (+) GCT. Methods: Pts with incurable refractory GCT that expressed Rb by immunohistochemistry were treated with PD-0332991 125 mg orally daily for 21 days followed by a 7 day break (cycle = 28 days). Tumor assessments were performed every 2 cycles. The primary endpoint was 6-month progression-free survival (PFS) rate. Results: As of 1/12/2012, archived tumors from 36 pts with refractory GCT were stained for Rb and 35 had ≥ 1+ staining. 18 of planned 24 pts have been enrolled and treated. Pt characteristics: 17 male, 1 female; median age, 31 years (range, 17-56); median ECOG performance status, 1 (range, 0-1); median number of prior chemotherapy regimens, 2 (range, 1-6); median number prior surgeries, 3 (range, 1-6). Pt pathology: mature teratoma (MT), 7; teratoma with malignant transformation (TMT), 7; mixed GCT, 2; late relapse (LR), 2. 16 pts are evaluable; 2 pts are too early to evaluate. 5 of 16 evaluable pts achieved 6-month PFS (3 MT, 1 TMT, 1 LR). Median PFS was 2 months (range, 0-17). No objective radiological responses were observed; 7 patients had best response of stable disease by RECIST criteria (3 MT, 3 TMT, 1 LR). Grade 3 toxicity included neutropenia (4 pts), thrombocytopenia (3 pts), anemia (1 pt), mucositis (1 pt). No grade 4 toxicity was seen. Analysis of archival tumor for predictive biomarkers including Rb and p16 expression is being performed. Conclusions: PD-0332991 has resulted in 6-month PFS in pts with refractory Rb + GCT, including pts with incurable teratomas.

Growing teratoma syndrome: Is it a subtype of germ-cell tumors or another entity?

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e16040-e16040
Author(s):  
Mutlu Dogan ◽  
Oznur Bal ◽  
Erkan Olcucuoglu ◽  
Efnan Algin ◽  
Nurullah Zengin
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumors ◽  
Primary Treatment ◽  
Salvage Chemotherapy ◽  
Growing Teratoma Syndrome ◽  
Metastatic Lesions ◽  
Interferon Α2b ◽  
Good Risk ◽  
Mixed Germ Cell Tumors

e16040 Background: Growing teratoma syndrome(GTS ) is a process presenting with growing masses despite normal tumor marker levels(TML) after chemotherapy in non-seminomatous germ cell tumors (NSGCT). Methods: GTS patients between 2000-2016 were evaluated for clinicopathological features and survival outcomes retrospectively. Results: 17 (6,4%) of 266 NSGCT had GTS. Median follow-up was 57.7 ( 13.8-132.7) months. Median age 27 (17-51) years . Most (n = 14) of them had mixed germ-cell tumors & 12 had mature/immature teratoma in primary pathology at diagnosis. Most (n = 11) of them had stage 3 disease & 10 had high TML (S1-3). 11 GTS patients had good risk NSGCT. All (n = 17) had 4 BEP(bleomycin, etoposide, cisplatin) cycles. Recurrence occured in retroperitoneum (n = 13), lung (n = 3) & brain (n = 1). They were considered as GTS since they had normal TML despite growing masses. 5 patients were referred to surgery without salvage chemotherapy and they had teratoma on postoperative surgery. 13 had surgery after salvage chemotherapy (TIP: taxane, ifosfamide, platin) but 4 had unresectable disease and they had clinical benefit with interferone α2b. Two operated patients had diffuse necrosis on pathology whereas others had documented teratoma. Median DFS was 12.3 ( 5.7-18.8) months whereas median OS was 64.8 (15.5-158) months. 3 patients had no recurrence after surgery for GTS. 9 had salvage chemotherapy (gemcitabine/oxaliplatin, TIP) for NSGCT metastatic lesions with TML elevation and 2 of them had autolog stem cell transplantation. Conclusions: GTS is rare in NSGCT, but it should be considered in NSGCT patients with both growing masses & normal TML after primary treatment approach. GTS patients surgery with resectable masses should be referred to surgery since teratoma without viable tumor seems to have less benefit from chemotherapy and/or radiotherapy. Interferon α2b might be an option in unresectable GTS.

A randomized trial of etoposide + cisplatin versus vinblastine + bleomycin + cisplatin + cyclophosphamide + dactinomycin in patients with good-prognosis germ cell tumors.

1988 ◽  
Vol 6 (8) ◽  
pp. 1231-1238 ◽  
Author(s):  
G J Bosl ◽  
N L Geller ◽  
D Bajorin ◽  
S P Leitner ◽  
A Yagoda ◽  
...  
Keyword(s):  
Germ Cell ◽  
Randomized Trial ◽  
Mature Teratoma ◽  
Germ Cell Tumors ◽  
Good Prognosis ◽  
Event Free Survival ◽  
Free Survival ◽  
Acute And Chronic Effects ◽  
Related Mortality

Standard chemotherapy for disseminated germ cell tumors (GCT) cures most patients but causes considerable acute toxicity, including treatment-related death due to septicemia during neutropenia and pulmonary fibrosis. In addition, chronic and delayed toxicities, particularly Raynaud's phenomenon, have been reported in 6% to 37% of treated patients. In an attempt to minimize the acute and chronic effects of treatment which are related primarily to vinblastine and bleomycin, a randomized trial comparing the efficacy and toxicity of vinblastine + bleomycin + cisplatin + cyclophosphamide + dactinomycin (VAB-6) and etoposide + cisplatin (EP) was conducted on 164 eligible patients with good-prognosis GCT. Seventy-nine of 82 (96%) patients receiving VAB-6 and 76/82 (93%) receiving EP achieved a complete remission (CR) with or without adjunctive surgery. Similar proportions of patients in both arms were found at surgery to have necrosis/fibrosis or mature teratoma. With a median follow-up of 24.4 months in the VAB-6 arm and 25.9 months in the EP arm, the total, relapse-free, and event-free survival distributions were similar in the two arms. Patients receiving EP experienced less emesis (P = .05), higher nadir WBC (P = .06) and platelet counts (P = .01), less magnesium wasting (P = .0001), less mucositis (P = .09), and no pulmonary toxicity. No treatment-related mortality was observed. EP is an efficacious and less toxic regimen and is recommended for good-prognosis patients with disseminated GCT.

Sign in / Sign up

Export Citation Format

Share Document