A Risk-adapted Study of Cisplatin and Etoposide, with or Without Ifosfamide, in Patients with Metastatic Seminoma: Results of the GETUG S99 Multicenter Prospective Study

Abstract

BackgroundWhether patients with good prognosis and intermediate/poor prognosis advanced seminoma should be treated differently has not been defined. ObjectiveTo assess a risk-adapted chemotherapy regimen in patients with advanced seminoma. Design, setting, and participantsA total of 132 patients were included in this prospective study. Patients with a good prognosis according to the International Germ Cell Cancer Collaboration Group (IGGCCG) were treated with four cycles of cisplatin-etoposide (EP). Patients with an intermediate prognosis according to the IGCCCG (or a poor prognosis according to the Medical Research Council classification) were treated with four cycles of VIP (EP and ifosfamide) and granulocyte colony-stimulating factor (G-CSF). Outcome measurements and statistical analysisSurvival curves were estimated using the Kaplan-Meier method. Results and limitationsThe median follow-up was 4.5 yr (range: 0.4–11.6 yr). Among 108 patients (82%) with a good prognosis who received EP, grade 3–4 toxicity included neutropenia (47%) and neutropenic fever (12%). Among the 24 patients (18%) with an intermediate/poor prognosis who received VIP plus G-CSF, toxicity included grade 3–4 neutropenia (36%), neutropenic fever (23%), thrombocytopenia (23%), anemia (23%), and a toxicity-related death (n=1; 4%). The 3-yr progression-free survival (PFS) rate was 93% (range: 85–97%) in the good prognosis group and 83% (range: 63–93%) in the intermediate/poor prognosis group (p=0.03 for PFS). The 3-yr overall survival (OS) rate was 99% (range: 92–100%) and 87% (range: 67–95%), respectively (p<0.005 for OS). Only four patients died of seminoma or its treatment. ConclusionsA risk-adapted chemotherapy policy for advanced seminoma yielded an excellent outcome with a 3-yr OS rate of 96%.