Clinical features of germ cell tumors (GCT) in men age 50 or older: Successful outcome and tolerability to chemotherapy for advanced disease.

Abstract

4656 Background: Most patients with GCT are diagnosed and treated below age 50. For patients ≥50, less is known about possible differences in biology, outcome and tolerability of treatment. Methods: We reviewed histology, primary tumor site and outcome for 4,176 males (median age at diagnosis 30, maximum age 82) seen at our center from 1990 to 2010 for management of GCT. Individual chart review was performed on men ≥50 receiving 1st-line platinum-based chemotherapy at our center (regardless of age at diagnosis) to characterize chemotherapy tolerance and outcome. Results: 229 patients (5.5%) were diagnosed at ≥50 (median age ≥50 group: 54; median age <50 group: 30), with significant differences in primary site and histology between the 2 groups (see table below). 59 men ≥50 received risk-directed 1st-line platinum chemotherapy (47 etoposide, cisplatin [EP]; 8 bleomycin + EP [BEP]; 4 with other regimens) for advanced GCT (48 good-, 7 intermediate-, 4 poor-risk), and 1 patient ≥50 received adjuvant EP. 5-year overall survival for the chemotherapy group (n=60) is 87% (95% CI 74-94). 36 (60%) had a treatment delay (≥ 7 days) with ≥1cycle and/or required a regimen change due to adverse events (delay: 55%; regimen change: 12%). 46 / 48 patients (96%) completed their planned course of EP, 2 patients discontinued EP due to toxicity. 6 / 8 men (75%) were unable to complete 4 cycles of BEP (5 due to pulmonary toxicity). Neutropenic fever with ≥ 1 cycle occurred in 43.3% of patients (50% with BEP, 40% with EP). Conclusions: GCT diagnosed at ≥50 has a distinct distribution of histologies and primary sites. Although complications and dose delays were frequent in those men ≥50 requiring chemotherapy, overall prognosis remains excellent when risk-directed treatment is given with curative intent. Prophylactic growth factor support is recommended with cisplatin chemotherapy for men ≥50 to reduce the incidence of neutropenic fever. Diagnosis <50 (%) [N= 3,949*] Diagnosis ≥50 (%) [N= 229*] P value Histology Seminoma 36.5 67.3 <0.0001 Nonseminoma 63.3 31.0 Spermatocytic seminoma 0.2 1.8 Primary site Testis 92.8 90.0 <0.0001 Retroperitoneum 0.8 3.5 Mediastinum 4.3 4.8 CNS 1.7 0 Other 0.4 1.7 *Two had second primary.