A risk-adapted study of cisplatin and etoposide, with or without ifosfamide, in patients with metastatic seminoma: results of the GETUG S99 multicenter prospective study

Eur Urol. 2014 Feb;65(2):381-6. doi: 10.1016/j.eururo.2013.09.004. Epub 2013 Sep 13.

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%.

Keywords: Chemotherapy; Prognostic factors; Seminoma.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Animals
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Cisplatin / administration & dosage
  • Disease-Free Survival
  • Etoposide / administration & dosage
  • France
  • Granulocyte Colony-Stimulating Factor / administration & dosage
  • Humans
  • Ifosfamide / administration & dosage
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • Seminoma / drug therapy*
  • Seminoma / mortality
  • Seminoma / secondary
  • Testicular Neoplasms / drug therapy*
  • Testicular Neoplasms / mortality
  • Testicular Neoplasms / pathology
  • Time Factors
  • Treatment Outcome
  • Young Adult

Substances

  • Granulocyte Colony-Stimulating Factor
  • Etoposide
  • Cisplatin
  • Ifosfamide