Cisplatin, Gemcitabine, and Paclitaxel as a Salvage Second-Line Therapy for Metastatic Germ-Cell Cancer

Clin Genitourin Cancer. 2021 Feb;19(1):e6-e11. doi: 10.1016/j.clgc.2020.05.014. Epub 2020 Jun 2.


Background: Second-line salvage therapy for patients with metastatic germ-cell cancer (GCC) after the first-line combination of VIP (etoposide, ifosfamide, cisplatin) therapy has not been established. This study evaluated the efficacy and tolerability of the TGP (paclitaxel, gemcitabine, cisplatin) combination chemotherapy as a second-line salvage therapy.

Patients and methods: The medical records of 16 consecutive patients with metastatic GCC who had been treated with first-line VIP therapy followed by second-line TGP therapy between 2005 and 2019 were reviewed and statistically analyzed. Ten patients, excluding the 6 patients treated with TGP without unequivocal progression, were included in the efficacy analysis. All 16 patients were included in the safety analysis.

Results: The median follow-up period from initial TGP administration was 78 months (interquartile range, 46-120 months). The estimated 5-year progression-free and overall survival rates for the 10 patients in the efficacy analysis were 70% and 100%, respectively. Grade 3/4 hematologic toxicity occurred in all 16 patients, but none developed uncontrollable infections or life-threatening bleeding. One patient died of treatment-related secondary leukemia, however.

Conclusion: The present study is to our knowledge the first to examine the therapeutic outcomes and safety profile of second-line TGP chemotherapy. VIP followed by TGP might be an alternative first- and second-line conventional regimen for patients with metastatic GCC in this granulocyte colony-stimulating factor era, especially for patients at a high risk of bleomycin-induced pulmonary toxicity.

Keywords: Germ cell cancer; Second-line; TGP; Toxicity; VIP.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Cisplatin* / adverse effects
  • Deoxycytidine / analogs & derivatives
  • Etoposide
  • Gemcitabine
  • Humans
  • Ifosfamide
  • Neoplasms, Germ Cell and Embryonal* / drug therapy
  • Paclitaxel / adverse effects
  • Salvage Therapy
  • Treatment Outcome


  • Deoxycytidine
  • Etoposide
  • Paclitaxel
  • Cisplatin
  • Ifosfamide
  • Gemcitabine