Abstract
Purpose The purpose of the study was to assess the efficacy of TIP as salvage chemotherapy for germ cell tumor (GCT) patients with relapsed disease or cisplatin (CDDP)-refractory disease and consolidation chemotherapy for patients who responded unfavorably to first-line chemotherapy.MethodsForty-three patients with advanced GCT were treated with TIP. Eleven with relapsed disease and five with CDDP-refractory disease received TIP as salvage chemotherapy. The remaining 27 received TIP as consolidation chemotherapy following initial induction chemotherapy. All patients received prophylactic granulocyte colony-stimulating factor.ResultsIn total, 116 cycles of TIP were administered with a median of three cycles (range 1–4 cycles) per patient. Before TIP, 33 patients showed elevated tumor marker and 23 patients (70 %) achieved marker normalization with the chemotherapy. One of six (17 %) patients with refractory disease and 5 of 10 (50 %) patients with relapsed disease achieved durable complete response (CR) after TIP with or without surgery. Eighteen of 27 (67 %) patients receiving TIP as consolidation chemotherapy achieved durable CR. Five additional patients were given further chemotherapy and achieved durable CR. Grade 4 leukocytopenia and thrombocytopenia were observed in 91 and 42 % of patients, respectively; all were managed with routine supportive care. Grade 2 and grade 3 sensory neuropathy was observed in 37 and 2 % of patients, respectively.ConclusionsThe TIP was effective for relapsed patients with favorable risk features and selected CDDP-refractory GCT patients. Results of TIP as consolidation for patients with unfavorable response to the initial chemotherapy were also encouraging. The toxicities were mainly myelosuppression and sensory neuropathy.
Highlights
About 80 % of patients with advanced germ cell tumor (GCT) can currently be cured with cisplatin-based chemotherapy and surgery, but patients who relapse after initial treatment or patients who did not respond completely to chemotherapy have a poor prognosis
The TIP was originally developed as first-line salvage chemotherapy for testicular germ cell cancer patients who relapsed after good response (CR or PRm−) to prior chemotherapy (Motzer et al 2000; Kondagunta et al 2005)
We evaluated the activity of TIP for GCT patients in three situations: salvage setting for relapsed cases, salvage setting for CDDP-refractory cases, and the consolidation setting as consolidation chemotherapy
Summary
About 80 % of patients with advanced germ cell tumor (GCT) can currently be cured with cisplatin-based chemotherapy and surgery, but patients who relapse after initial treatment or patients who did not respond completely to chemotherapy have a poor prognosis. Large retrospective analysis suggests a benefit from HDCT as the first salvage chemotherapy (Lorch et al 2011), the treatment is not feasible for all patients. Another approach is risk-adapted management in a salvage setting. J Cancer Res Clin Oncol (2015) 141:127–133 ifosfamide conventional-dose salvage therapy: (1) testicular GCT, (2) prior treatment limited to one program or six or fewer cycles of cisplatin, and (3) progression after either a CR or a partial response (PR) with normal serum tumor markers (McCaffrey et al 1997). Motzer et al conducted a prospective study with a combination of paclitaxel, ifosfamide, and cisplatin (TIP) as salvage therapy for relapsed patients having those favorable risk features (Motzer et al 2000). The results were confirmed in a subsequent MSKCC study treating 46 patients with the same regimen (Kondagunta et al 2005)
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