Long-term survival after treatment with gemcitabine and oxaliplatin with and without paclitaxel plus secondary surgery in patients with cisplatin-refractory and/or multiply relapsed germ cell tumors

Eur Urol. 2011 Oct;60(4):850-5. doi: 10.1016/j.eururo.2011.06.019. Epub 2011 Jun 24.

Abstract

Background: Chemotherapy including gemcitabine, oxaliplatin, and/or paclitaxel has shown efficacy in germ cell tumor patients after progression during cisplatin-based chemotherapy or relapse after high-dose chemotherapy including complete responses in 5-15%.

Objective: Most studies have been published with a short follow-up. We present the long-term outcome of two previously reported trials.

Design, setting, and participants: Two phase 2 trials have evaluated chemotherapy with gemcitabine plus oxaliplatin alone (GO) or plus paclitaxel (GOP) including a total of 76 patients (35 GO and 41 GOP). At first publication, 29 patients were still alive and 9 patients (12%) were free of disease after chemotherapy with or without surgery: GO, 3 of 35 (9%) and GOP, 6 of 41 (15%).

Measurements: Survival and follow-up time were calculated using the Kaplan-Meier method from the beginning of study treatment until the date of death or the date of the last follow-up.

Results and limitations: After a median follow-up of 19 mo (2-86 mo) for the 29 patients still alive, 11% of all patients (8 of 76) were free of disease for >2 yr: 1 of 35 patients (3%) after GO and 7 of 41 patients (17%) after GOP. Three patients with complete remission (CR), two after GO and one after GOP, relapsed. Two others treated with GOP were rendered disease free: One patient with partial remission and short follow-up underwent secondary surgery, and another patient, who had relapsed 2 mo after GOP, achieved a CR after salvage treatment. Overall survival time is ≥33 mo (range: ≥ 28-59 mo) in these eight patients.

Conclusions: Long-term survival can be achieved in about 10-15% of patients with cisplatin-refractory or multiply relapsed germ cell tumor with GO(P) chemotherapy. Aggressive secondary surgery following partial remission is a crucial part of this salvage treatment.

MeSH terms

  • Adult
  • Antineoplastic Agents / therapeutic use*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Cisplatin / therapeutic use*
  • Clinical Trials, Phase II as Topic
  • Deoxycytidine / analogs & derivatives*
  • Deoxycytidine / therapeutic use
  • Humans
  • Male
  • Middle Aged
  • Neoplasms, Germ Cell and Embryonal / drug therapy
  • Neoplasms, Germ Cell and Embryonal / mortality*
  • Neoplasms, Germ Cell and Embryonal / surgery
  • Organoplatinum Compounds / therapeutic use*
  • Oxaliplatin
  • Paclitaxel / therapeutic use*
  • Retrospective Studies
  • Salvage Therapy
  • Testicular Neoplasms / drug therapy
  • Testicular Neoplasms / mortality*
  • Testicular Neoplasms / surgery
  • Treatment Outcome
  • Young Adult

Substances

  • Antineoplastic Agents
  • Organoplatinum Compounds
  • Oxaliplatin
  • Deoxycytidine
  • gemcitabine
  • Paclitaxel
  • Cisplatin