Jakob Lauritsen1, Maria G G Kier1, Mette S Mortensen1, Mikkel Bandak1, Ramneek Gupta1, Niels V Holm1, Mads Agerbaek1, Gedske Daugaard2. 1. Jakob Lauritsen, Maria G.G. Kier, Mette S. Mortensen, Mikkel Bandak, and Gedske Daugaard, Copenhagen University Hospital, Copenhagen; Maria G.G. Kier, Danish Cancer Society Research Center, Strandboulevarden, Copenhagen; Ramneek Gupta, Technical University of Denmark, Kongens Lyngby; Niels V. Holm, Odense University Hospital, Odense; and Mads Agerbaek, Aarhus University Hospital, Aarhus, Denmark. 2. Jakob Lauritsen, Maria G.G. Kier, Mette S. Mortensen, Mikkel Bandak, and Gedske Daugaard, Copenhagen University Hospital, Copenhagen; Maria G.G. Kier, Danish Cancer Society Research Center, Strandboulevarden, Copenhagen; Ramneek Gupta, Technical University of Denmark, Kongens Lyngby; Niels V. Holm, Odense University Hospital, Odense; and Mads Agerbaek, Aarhus University Hospital, Aarhus, Denmark. kirsten.gedske.daugaard@regionh.dk.
Abstract
PURPOSE: A small number of patients with germ cell cancer (GCC) receive more than one line of treatment for disseminated disease. The purpose of this study was to evaluate late toxicity and survival in an unselected cohort of patients who experienced relapse after receiving first-line treatment for disseminated disease. METHODS: From the Danish Testicular Cancer database, we identified all patients who received more than one line of treatment for disseminated disease. Information about late toxicity and mortality was obtained by means of linkage to national registers. Prognostic factors for relapse and death were identified and compared with the International Prognostic Factors Study Group (IPFSG) classification. RESULTS: In total, 268 patients received more than one line of treatment for disseminated GCC. Approximately half of patients (n=136) died as a result of GCC. The 132 remaining patients, compared with patients treated with only orchiectomy, had an increased risk for a second cancer (hazard ratio [HR], 3.2; 95% CI, 1.9 to 5.5), major cardiovascular disease (HR, 1.9; 95% CI, 1.0 to 3.3), pulmonary disease (HR, 2.0; 95% CI, 1.0 to 3.8), GI disease (HR, 7.3; 95% CI, 3.6 to 14.8), renal impairment (HR, 8.3; 95% CI, 3.0 to 23.2), neurologic disorders (HR, 6.3; 95% CI, 3.1 to 12.6), and death as a result of other causes (HR, 2.6; 95% CI, 1.6 to 4.2). In large part, the IPFSG classification was confirmed in our population; however, we could not confirm the primary site and the level of human chorionic gonadotropin as independent factors. We identified increasing age as a possible new prognostic factor for treatment failure after second-line treatment (HR, 1.2 per 10 years; 95% CI, 1.2 to 15). CONCLUSION: Patients with GCC who survive after more than one line of treatment for disseminated disease have a highly increased risk of late toxicity and death as a result of causes other than GCC. Therefore, they should be candidates for life-long follow-up. The IPFSG classification was confirmed in this unselected population.
PURPOSE: A small number of patients with germ cell cancer (GCC) receive more than one line of treatment for disseminated disease. The purpose of this study was to evaluate late toxicity and survival in an unselected cohort of patients who experienced relapse after receiving first-line treatment for disseminated disease. METHODS: From the Danish Testicular Cancer database, we identified all patients who received more than one line of treatment for disseminated disease. Information about late toxicity and mortality was obtained by means of linkage to national registers. Prognostic factors for relapse and death were identified and compared with the International Prognostic Factors Study Group (IPFSG) classification. RESULTS: In total, 268 patients received more than one line of treatment for disseminated GCC. Approximately half of patients (n=136) died as a result of GCC. The 132 remaining patients, compared with patients treated with only orchiectomy, had an increased risk for a second cancer (hazard ratio [HR], 3.2; 95% CI, 1.9 to 5.5), major cardiovascular disease (HR, 1.9; 95% CI, 1.0 to 3.3), pulmonary disease (HR, 2.0; 95% CI, 1.0 to 3.8), GI disease (HR, 7.3; 95% CI, 3.6 to 14.8), renal impairment (HR, 8.3; 95% CI, 3.0 to 23.2), neurologic disorders (HR, 6.3; 95% CI, 3.1 to 12.6), and death as a result of other causes (HR, 2.6; 95% CI, 1.6 to 4.2). In large part, the IPFSG classification was confirmed in our population; however, we could not confirm the primary site and the level of human chorionic gonadotropin as independent factors. We identified increasing age as a possible new prognostic factor for treatment failure after second-line treatment (HR, 1.2 per 10 years; 95% CI, 1.2 to 15). CONCLUSION:Patients with GCC who survive after more than one line of treatment for disseminated disease have a highly increased risk of late toxicity and death as a result of causes other than GCC. Therefore, they should be candidates for life-long follow-up. The IPFSG classification was confirmed in this unselected population.
Authors: Harmke J Groot; Flora E van Leeuwen; Sjoukje Lubberts; Simon Horenblas; Ronald de Wit; J Alfred Witjes; Gerard Groenewegen; Philip M Poortmans; Maarten C C M Hulshof; Otto W M Meijer; Igle J de Jong; Hetty A van den Berg; Tineke J Smilde; Ben G L Vanneste; Maureen J B Aarts; Katarzyna Jóźwiak; Alexandra W van den Belt-Dusebout; Jourik A Gietema; Michael Schaapveld Journal: Cancer Date: 2019-11-15 Impact factor: 6.860