Abstract
BackgroundEtoposide (E) at 100 mg/m2 combined with Cisplatin (P) at 20 mg/m2 represents an induction 2-day regimen embedded in our clinical practice for patients with advanced GCT or TN at high risk of early death. We evaluated 24/7 Em-EP administration to a combined GCT-TN cohort at our Emergency Cancer Treatment Centre (ECTC) to determine its efficacy within the acute setting.MethodsPatients who received Em-EP during a five-year interval were identified from electronic databases at Imperial College Healthcare NHS Trust. Data collected included demographics, treatment details and clinical outcome.ResultsEm-EP was administered in the emergency setting to 104 patients, predominantly young adults (median age 35, range 17–71). Half the cases were GCT (n = 52): 22 male (6 seminomas, 13 non-seminomas); 30 female (2 dysgerminomas, 28 non-dysgerminomas). The other 50% were treated for TN (n = 52): 45 gestational (GTN) and 7 non-gestational. Most patients received Em-EP for a new cancer diagnosis (n = 100, 96%), within 24 h (n = 93, 89%) and out-of-hours (n = 74, 70%). Indications for Em-EP included symptomatic disease (n = 66, 63%), high-burden disease, (n = 51, 49%) and organ failure requiring Intensive Care Unit support (n = 9, 9%). Neutropenic sepsis was observed in 5%. Four-week overall survival after Em-EP administration was 98%.ConclusionsDespite the potentially fatal complications encountered in the acute setting, early mortality with Em-EP is low at our ECTC. Specialist units that treat unwell patients with advanced GCT or TN should consider making Em-EP available 24/7 for emergency administration. Its efficacy within a prospective cohort and in other platinum-sensitive malignancies requires evaluation.
Highlights
Etoposide (E) at 100 mg/m2 combined with Cisplatin (P) at 20 mg/m2 represents an induction 2-day regimen embedded in our clinical practice for patients with advanced Germ cell tumours (GCT) or trophoblastic neoplasia (TN) at high risk of early death
Germ cell tumours (GCT) and trophoblastic neoplasia (TN) are highly chemosensitive diseases that can present with life-threatening complications in teenagers and young adults [21, 22]
Patients treated with Emergency Etoposide-Cisplatin (Em-EP) Between 1st January 2012 and 31st December 2016, EmEP was administered to 104 patients in the acute setting, predominantly to young adults with a median age 35
Summary
Etoposide (E) at 100 mg/m2 combined with Cisplatin (P) at 20 mg/m2 represents an induction 2-day regimen embedded in our clinical practice for patients with advanced GCT or TN at high risk of early death. Germ cell tumours (GCT) and trophoblastic neoplasia (TN) are highly chemosensitive diseases that can present with life-threatening complications in teenagers and young adults [21, 22]. An advanced stage at presentation further compromises the favourable clinical outcome that is frequently associated with these disease types when diagnosed at an early stage [21, 22]. Patients with intracranial metastases harbour a less favourable prognosis and can present symptomatically [8]. TN patients with advanced disease are at high risk of early death from fatal haemorrhage [13, 14]
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