Early experience with chemotherapy intensification for poor-prognosis metastatic germ cell cancer and unfavorable tumor marker decline

  • Anupam Batra Western University and London Health Sciences Centre
  • Scott Ernst Western University and London Health Sciences Centre
  • Kylea Potvin Western University and London Health Sciences Centre
  • Ricardo Fernandes Western University and London Health Sciences Centre
  • Nicholas Power Western University and London Health Sciences Centre
  • James Vanhie
  • Eric Winquist Western University and London Health Sciences Centre
Keywords: germ cell cancer, drug therapy, tumor markers, intensification, chemotherapy

Abstract

Introduction: Intensified chemotherapy improved outcomes for men with poor-prognosis metastatic germ cell cancer (GCC) and unfavorable tumor marker decline after one cycle of bleomycin, etoposide, and cisplatin (BEP) chemotherapy in the GETUG-13 trial. Herein, we report our experience to date using a similar approach.

Methods: Patients were identified from our electronic GCC database. Men with poor-prognosis GCC and unfavorable tumor marker decline were offered intensified chemotherapy consisting of T-BEP (three cycles) plus paclitaxel, ifosfamide, and cisplatin (TIP) (one cycle), along with prophylactic granulocyte-colony stimulating factor (G-CSF) and resection of residual masses. Cisplatin, etoposide, and ifosfamide (PEI) replaced the last cycle of T-BEP for bleomycin pulmonary concerns. Serious toxicities, progression-free survival, and overall survival were evaluated retrospectively.

Results: Ten patients with poor-prognosis GCC were identified from May 2012 to April 2016. Eight patients had unfavorable tumor marker decline. Six were offered and received intensified chemotherapy (two T-BEPx3 + TIP and four T-BEPx2 + PEI + TIP). Serious toxicities included neutropenic sepsis, deep venous thrombosis, and C. difficile colitis, but there were no toxic deaths. One patient died of synchronous metastatic adenocarcinoma ex teratoma. The remaining five patients achieved marker-negative partial response, two had residual mature teratoma excised, and four have no evidence of disease after surgery. All are alive at a median of 63.5 months (range 46.3-65.6); one patient has grade 2 peripheral sensory neuropathy, and one patient has grade 2 cognitive disturbance. Of four patients treated with standard BEP, two have died of disease and two are alive at 51.4 and 53.6 months.

Conclusions: Our experience with intensified chemotherapy for men with poor-prognosis GCC and unfavorable tumor marker decline confirms that it is feasible, reasonably safe, and appears to provide results similar to those reported in GETUG-13.

Author Biographies

Anupam Batra, Western University and London Health Sciences Centre

Medical Oncologist

Division of Medical Oncology, Department of Oncology

Scott Ernst, Western University and London Health Sciences Centre

Medical Oncologist

Division of Medical Oncology, Department of Oncology

Kylea Potvin, Western University and London Health Sciences Centre

Medical Oncologist

Division of Medical Oncology, Department of Oncology

Ricardo Fernandes, Western University and London Health Sciences Centre

Medical Oncologist

Division of Medical Oncology, Department of Oncology

Nicholas Power, Western University and London Health Sciences Centre

Urologic Oncologist

Division of Urology, Department of Surgery

Eric Winquist, Western University and London Health Sciences Centre

Medical Oncologist

Division of Medical Oncology, Department of Oncology

Published
2019-07-23
How to Cite
Batra, A., Ernst, S., Potvin, K., Fernandes, R., Power, N., Vanhie, J., & Winquist, E. (2019). Early experience with chemotherapy intensification for poor-prognosis metastatic germ cell cancer and unfavorable tumor marker decline. Canadian Urological Association Journal, 14(2), 43-7. https://doi.org/10.5489/cuaj.5802
Section
Original Research