Stefanie Fischer1,2, Torgrim Tandstad3,4, Gabriella Cohn-Cedermark4,5, Constance Thibault6, Bruno Vincenzi7, Dirk Klingbiel8, Costantine Albany9, Andrea Necchi10, Angelika Terbuch11, Anja Lorch12, Jorge Aparicio13, Axel Heidenreich14, Marcus Hentrich15, Matthew Wheater16, Carl W Langberg4,17, Olof Ståhl4,18, Christian Daniel Fankhauser19, Anis A Hamid20, Konstantinos Koutsoukos21, Jonathan Shamash22, Jeff White23, Carsten Bokemeyer24, Jörg Beyer25, Silke Gillessen1,2,26,27. 1. Cantonal Hospital St Gallen, Department of Medical Oncology and Hematology, St. Gallen, Switzerland. 2. Manchester Cancer Research Centre, Division of Cancer Sciences, University of Manchester, and The Christie NHS Foundation Trust, Manchester, United Kingdom. 3. The Cancer Clinic, St Olavs University Hospital, Trondheim, Norway. 4. SWENOTECA, Trondheim, Norway. 5. Department of Oncology-Pathology, Karolinska Institute, Stockholm, and Department of Oncology, Karolinska University Hospital, Stockholm, Sweden. 6. Department of Medical Oncology, Hôpital Européen Georges Pompidou, Paris, France. 7. University Campus Bio-Medico, Rome, Italy. 8. F Hoffmann-La Roche Ltd, Basel, Switzerland. 9. Indiana University School of Medicine, Melvin and Bren Simon Cancer Center, Indianapolis, IN. 10. Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 11. Abteilung für Onkologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Austria. 12. Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland. 13. Hospital Universitari I Politècnic La Fe, Valencia, Spain, Spanish Germ Cell Cancer Group. 14. Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany. 15. Department of Hematology and Oncology, Red Cross Hospital, University of Munich, Munich, Germany. 16. Medical Oncology, University Hospital Southampton, Southampton, United Kingdom. 17. The Cancer Centre, Oslo University Hospital, Oslo, Norway. 18. Department of Oncology, Skane University Hospital, Lund, Sweden. 19. University of Zürich, Zürich, Switzerland. 20. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA. 21. National & Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece. 22. St Bartholomew's Hospital, London, United Kingdom. 23. Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom. 24. Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany. 25. University Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. 26. University of Bern, Bern, Switzerland. 27. Oncology Institute of Southern Switzerland, Bellinzona and Universita della Svizzera Italiana, Lugano, Switzerland.
Abstract
PURPOSE: Clinical stage I (CSI) nonseminoma (NS) is a disease limited to the testis without metastases. One treatment strategy after orchiectomy is adjuvant chemotherapy. Little is known about the outcome of patients who experience relapse after such treatment. PATIENTS AND METHODS: Data from 51 patients with CSI NS who experienced a relapse after adjuvant bleomycin, etoposide, and cisplatin (BEP) from 18 centers/11 countries were collected and retrospectively analyzed. Primary outcomes were overall and progression-free survivals calculated from day 1 of treatment at first relapse. Secondary outcomes were time to, stage at, and treatment of relapse and rate of subsequent relapses. RESULTS: Median time to relapse was 13 months, with the earliest relapse 2 months after start of adjuvant treatment and the latest after 25 years. With a median follow-up of 96 months, the 5-year PFS was 67% (95% CI, 54% to 82%) and the 5-year OS was 81% (95% CI, 70% to 94%). Overall, 19 (37%) of 51 relapses occurred later than 2 years. Late relapses were associated with a significantly higher risk of death from NS (hazard ratio, 1.10 per year; P = .01). Treatment upon relapse was diverse: the majority of patients received a combination of chemotherapy and surgery. Twenty-nine percent of patients experienced a subsequent relapse. At last follow-up, 41 patients (80%) were alive and disease-free, eight (16%) had died of progressive disease, and one patient (2%) each had died from therapy-related or other causes. CONCLUSION: Outcomes of patients with relapse after adjuvant BEP seem better compared with patients who experience relapse after treatment of metastatic disease but worse compared with those who have de-novo metastatic disease. We found a substantial rate of late and subsequent relapses. There seem to be three patterns of relapse with different outcomes: pure teratoma, early viable NS relapse (< 2 years), and late viable NS relapse (> 2 years).
PURPOSE: Clinical stage I (CSI) nonseminoma (NS) is a disease limited to the testis without metastases. One treatment strategy after orchiectomy is adjuvant chemotherapy. Little is known about the outcome of patients who experience relapse after such treatment. PATIENTS AND METHODS: Data from 51 patients with CSI NS who experienced a relapse after adjuvant bleomycin, etoposide, and cisplatin (BEP) from 18 centers/11 countries were collected and retrospectively analyzed. Primary outcomes were overall and progression-free survivals calculated from day 1 of treatment at first relapse. Secondary outcomes were time to, stage at, and treatment of relapse and rate of subsequent relapses. RESULTS: Median time to relapse was 13 months, with the earliest relapse 2 months after start of adjuvant treatment and the latest after 25 years. With a median follow-up of 96 months, the 5-year PFS was 67% (95% CI, 54% to 82%) and the 5-year OS was 81% (95% CI, 70% to 94%). Overall, 19 (37%) of 51 relapses occurred later than 2 years. Late relapses were associated with a significantly higher risk of death from NS (hazard ratio, 1.10 per year; P = .01). Treatment upon relapse was diverse: the majority of patients received a combination of chemotherapy and surgery. Twenty-nine percent of patients experienced a subsequent relapse. At last follow-up, 41 patients (80%) were alive and disease-free, eight (16%) had died of progressive disease, and one patient (2%) each had died from therapy-related or other causes. CONCLUSION: Outcomes of patients with relapse after adjuvant BEP seem better compared with patients who experience relapse after treatment of metastatic disease but worse compared with those who have de-novo metastatic disease. We found a substantial rate of late and subsequent relapses. There seem to be three patterns of relapse with different outcomes: pure teratoma, early viable NS relapse (< 2 years), and late viable NS relapse (> 2 years).
Authors: Anja Lorch; Caroline Bascoul-Mollevi; Andrew Kramar; Lawrence Einhorn; Andrea Necchi; Christophe Massard; Ugo De Giorgi; Aude Fléchon; Kim Margolin; Jean-Pierre Lotz; Jose Ramon Germà-Lluch; Thomas Powles; Christian Kollmannsberger; Jörg Beyer Journal: J Clin Oncol Date: 2011-03-28 Impact factor: 44.544
Authors: Duncan C Gilbert; Andrew R Norman; Judith Nicholl; David P Dearnaley; Alan Horwich; Robert A Huddart Journal: BJU Int Date: 2006-07 Impact factor: 5.588
Authors: Mehdi Shahidi; Andrew R Norman; David P Dearnaley; Judy Nicholls; Alan Horwich; Robert A Huddart Journal: Cancer Date: 2002-08-01 Impact factor: 6.860
Authors: David S Sharp; Brett S Carver; Scott E Eggener; G Varuni Kondagunta; Robert J Motzer; George J Bosl; Joel Sheinfeld Journal: J Clin Oncol Date: 2008-10-20 Impact factor: 44.544
Authors: Robert J Hamilton; Christina Canil; Noa Shani Shrem; Kopika Kuhathaas; Maria Di Jiang; Peter Chung; Scott North; Piotr Czaykowski; Sebastien Hotte; Eric Winquist; Christian Kollmannsberger; Armen Aprikian; Denis Soulières; Scott Tyldesley; Alan I So; Nicholas Power; Ricardo A Rendon; Martin O'Malley; Lori Wood; Michael A S Jewett Journal: Can Urol Assoc J Date: 2022-06 Impact factor: 2.052
Authors: Klaus-Peter Dieckmann; Tomas Pokrivcak; Lajos Geczi; David Niehaus; Inken Dralle-Filiz; Cord Matthies; Tamas Dienes; Stefanie Zschäbitz; Pia Paffenholz; Tanja Gschliesser; Renate Pichler; Michal Mego; Pia Bader; Friedemann Zengerling; Julia Heinzelbecker; Philipp Krausewitz; Susanne Krege; Gaetano Aurilio; Cem Aksoy; Marcus Hentrich; Christoph Seidel; Péter Törzsök; Tim Nestler; Matthaeus Majewski; Andreas Hiester; Tomas Buchler; Sonia Vallet; Hana Studentova; Sandra Schönburg; Dora Niedersüß-Beke; Julia Ring; Emanuela Trenti; Axel Heidenreich; Christian Wülfing; Hendrik Isbarn; Uwe Pichlmeier; Martin Pichler Journal: Ther Adv Med Oncol Date: 2022-03-31 Impact factor: 8.168