The importance of etoposide dose intensity in the management of metastatic germ cell tumours and the role of paclitaxel in salvage treatment of relapsing patients

Abstract

14502 Background: The primary objective was to evaluate the effect of etoposide dose intensity in the standard cisplatin/etoposide/bleomycin (PEB) regimen on progression free (PFS) and overall survival (OS). Secondary objectives were and to determine how the addition of paclitaxel in salvage regimens impacts OS and to compare the risk distribution of germ cell patients seen at a tertiary care centre to that quoted in the International Germ Cell Consensus Classification (IGCCC). Methods: A retrospective chart review of all 302 germ cell patients requiring cisplatin-based chemotherapy between January 1980 and December 2004 was conducted. Data collected on initial treatment included the dose of etoposide: 500 mg/m2/cycle (E500) or 360 mg/m2/cycle (E360) and whether the salvage treatment contained paclitaxel or not. PFS and OS were calculated. Patients were risk stratified as per IGCCC variables. Results: In the PEB regimen, E500 is superior to E360 as it results in a relapse rate of only 3% and an overall survival of 97% compared to a relapse rate and survival of 29% and 80% respectively. The addition of paclitaxel to salvage chemotherapy regimens for patients relapsing results in 1/5 (20%) of patients dying compared to 26/39 (67%) for those receiving a non-paclitaxel based salvage regimen. The distribution of seminoma patients was similar to the IGCCC (90% good risk, 10% intermediate risk). Non-seminoma (NS) patients were skewed to the good-risk category: 71% good risk, 10% intermediate risk and 18% poor risk as compared to 56%, 28% and 16% respectively as reported by the IGCCC. 5-year PFS and OS were comparable to those documented by the IGCCC with the exception of the intermediate risk NS patients where our 5 year PFS was 48% compared to 75% expected but 5 year OS was similar in these patients (75% Vs. 80%). Conclusions: This review demonstrates that PEB treatment containing higher dose etoposide is superior in terms of PFS and OS. Although the sample size is small it appears that Paclitaxel containing salvage regimens results in superior outcomes compared to previously used salvage regimens. Our centre has a similar risk distribution of patients as that quoted by the IGCCC. No significant financial relationships to disclose.