Karim Fizazi1, Rémi Delva2, Armelle Caty3, Christine Chevreau4, Pierre Kerbrat5, Frederic Rolland6, Frank Priou7, Lionnel Geoffrois8, Olivier Rixe9, Philippe Beuzeboc10, Jean-Pierre Malhaire11, Stephane Culine12, Marie-Stephanie Aubelle13, Agnes Laplanche13. 1. Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France. Electronic address: fizazi@igr.fr. 2. Department of Medical Oncology, Centre Paul Papin, Angers, France. 3. Radiotherapy and Oncology, Centre Galilée, Hôpital Privé La Louvière, Lille, France. 4. Centre Claudius Regaud, Toulouse, France. 5. Department of Medical Oncology, Centre Eugène Marquis, Rennes, France. 6. Department of Medical Oncology, Centre René Gauducheau, Saint-Herblain, France. 7. Service of Internal Medical Onco-Haematology, Hôpital Les Oudairies, La Roche sur Yon, France. 8. Medical Oncology, Department of Clinical Oncology, Centre Alexis Vautrin, Vandoeuvre lès Nancy, France. 9. GRU Cancer Center, Department of Hematology Oncology, Augusta, GA, USA. 10. Department of Medical Oncology, Institut Curie, Paris, France. 11. Department of Radiotherapy, Hôpital Morvan, Brest, France. 12. Department of Medical Oncology, Hôpital Saint-Louis, Paris, France. 13. Department of Biostatic and Epidemiology, Institut Gustave Roussy, Villejuif, France.
Abstract
BACKGROUND: Whether patients with good prognosis and intermediate/poor prognosis advanced seminoma should be treated differently has not been defined. OBJECTIVE: To assess a risk-adapted chemotherapy regimen in patients with advanced seminoma. DESIGN, SETTING, AND PARTICIPANTS: A total of 132 patients were included in this prospective study. Patients with a good prognosis according to the International Germ Cell Cancer Collaboration Group (IGGCCG) were treated with four cycles of cisplatin-etoposide (EP). Patients with an intermediate prognosis according to the IGCCCG (or a poor prognosis according to the Medical Research Council classification) were treated with four cycles of VIP (EP and ifosfamide) and granulocyte colony-stimulating factor (G-CSF). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Survival curves were estimated using the Kaplan-Meier method. RESULTS AND LIMITATIONS: The median follow-up was 4.5 yr (range: 0.4-11.6 yr). Among 108 patients (82%) with a good prognosis who received EP, grade 3-4 toxicity included neutropenia (47%) and neutropenic fever (12%). Among the 24 patients (18%) with an intermediate/poor prognosis who received VIP plus G-CSF, toxicity included grade 3-4 neutropenia (36%), neutropenic fever (23%), thrombocytopenia (23%), anemia (23%), and a toxicity-related death (n=1; 4%). The 3-yr progression-free survival (PFS) rate was 93% (range: 85-97%) in the good prognosis group and 83% (range: 63-93%) in the intermediate/poor prognosis group (p=0.03 for PFS). The 3-yr overall survival (OS) rate was 99% (range: 92-100%) and 87% (range: 67-95%), respectively (p<0.005 for OS). Only four patients died of seminoma or its treatment. CONCLUSIONS: A risk-adapted chemotherapy policy for advanced seminoma yielded an excellent outcome with a 3-yr OS rate of 96%.
BACKGROUND: Whether patients with good prognosis and intermediate/poor prognosis advanced seminoma should be treated differently has not been defined. OBJECTIVE: To assess a risk-adapted chemotherapy regimen in patients with advanced seminoma. DESIGN, SETTING, AND PARTICIPANTS: A total of 132 patients were included in this prospective study. Patients with a good prognosis according to the International Germ Cell Cancer Collaboration Group (IGGCCG) were treated with four cycles of cisplatin-etoposide (EP). Patients with an intermediate prognosis according to the IGCCCG (or a poor prognosis according to the Medical Research Council classification) were treated with four cycles of VIP (EP and ifosfamide) and granulocyte colony-stimulating factor (G-CSF). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Survival curves were estimated using the Kaplan-Meier method. RESULTS AND LIMITATIONS: The median follow-up was 4.5 yr (range: 0.4-11.6 yr). Among 108 patients (82%) with a good prognosis who received EP, grade 3-4 toxicity included neutropenia (47%) and neutropenic fever (12%). Among the 24 patients (18%) with an intermediate/poor prognosis who received VIP plus G-CSF, toxicity included grade 3-4 neutropenia (36%), neutropenic fever (23%), thrombocytopenia (23%), anemia (23%), and a toxicity-related death (n=1; 4%). The 3-yr progression-free survival (PFS) rate was 93% (range: 85-97%) in the good prognosis group and 83% (range: 63-93%) in the intermediate/poor prognosis group (p=0.03 for PFS). The 3-yr overall survival (OS) rate was 99% (range: 92-100%) and 87% (range: 67-95%), respectively (p<0.005 for OS). Only four patients died of seminoma or its treatment. CONCLUSIONS: A risk-adapted chemotherapy policy for advanced seminoma yielded an excellent outcome with a 3-yr OS rate of 96%.
Authors: Mikhail Fedyanin; Alexey Tryakin; Anatoly Bulanov; Anna Vybarava; Alexandra Tjulandina; Dzhennet Chekini; Olga Sekhina; Konstantin Figurin; August Garin; Sergei Tjulandin Journal: J Cancer Res Clin Oncol Date: 2015-01-14 Impact factor: 4.553