Salvage chemotherapy with paclitaxel, gemcitabine, and nedaplatin (TGN) for cisplatin refractory heavily treated germ cell tumors.

Abstract

e15089 Background: Only 20-30% of patients with cisplatin (CDDP) refractory germ cell tumor (GCT) will remain continuously disease free with salvage chemotherapy. The present study investigated the chemotherapy with paclitaxel (PTX) in combination with gemcitabine (GEM) and nedaplatin (CDGP), which is a derivative of CDDP, as salvage chemotherapy for CDDP refractory GCT. Methods: Between Jan 2003 and Dec 2010, 16 patients with CDDP refractory GCT were enrolled. All patients were male, with mean age 33 (range: 19-51). Median number of previous chemotherapy was 12 (range: 9-26) cycles. The combination chemotherapy consisted of PTX: 210 mg/m2 on day 1, CDGP 100 mg/m2 on day 2 and GEM: 1000mg/m2 on day 1 and 8 every three weeks. Results: A median of 4 cycles (range: 2-10) of TGN therapy was administered to 16 patients. Grade 3/4 toxicities were reported as follows: neutropenia: 100%, thrombocytopenia: 92%, anemia: 71%. No treatment related death was observed. Response rate was 56.3% (CR: 0 %, PRm-: 25%, PRm+: 31.3%, NC: 0%, PD: 43.7%). Unfortunately, no patients achieved a no evidence of disease status with a median duration of follow-up of 15 months (2-80 months). Six patients (37.5%) remain alive with disease. However, 10 patients (62.5%) died of the disease. Conclusions: This study demonstrates that combination chemotherapy with PTX, GEM and CDGP showed moderate anticancer activity for patients with CDDP refractory GCT without severe adverse events. These findings suggest that TGN therapy might be one of the options of salvage chemotherapy for CDDP refractory GCT and may be assessed as second or third line therapy.