Skip to main content
PMC home page
British Journal of Cancer logoLink to British Journal of Cancer
. 1996 Oct;74(8):1280–1285. doi: 10.1038/bjc.1996.530

Advances in the management of metastatic non-seminomatous germ cell tumours during the cisplatin era: a single-institution experience.

A Gerl 1, C Clemm 1, N Schmeller 1, R Hartenstein 1, R Lamerz 1, W Wilmanns 1
PMCID: PMC2075932  PMID: 8883418

Abstract

Long-term outcome was reviewed in 266 consecutive patients with metastatic non-seminomatous germ cell tumours treated at a single institution. The overall 3 year survival was 77%, and 3 year progression-free survival was 71%. Multivariate analysis identified the following clinical features as independent prognostic factors: the presence of liver, bone or brain metastasis, serum human chorionic gonadotropin > or = 10000 U l-1 and/or alpha-fetoprotein > or = 1000 ng ml-1, a mediastinal mass > 5 cm and the presence of 20 or more lung metastases. Age was not of prognostic significance. Patients without any of the above poor-risk factors had a 3 year survival of 91% regardless of etoposide- or vinblastine-containing chemotherapy compared with 61% for the remaining patients. However, etoposide-containing protocols led to significantly improved survival in patients with at least one poor risk factor. After 612 patient-years of observation no case of secondary leukaemia was observed among 119 surviving patients who had received etoposide as part of their treatment. With a median follow-up of 93 months, five patients developed a second germ cell tumour, two patients nongerm cell malignancies. Fourteen patients relapsed after a disease-free interval of more than 2 years, and nine patients died more than 5 years after commencement of treatment underscoring the need to report long-term results. There is some evidence that cumulative experience translates into improved survival and cure rates for patients with poor-risk metastatic disease.

Full text

PDF
1282

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aass N., Klepp O., Cavallin-Stahl E., Dahl O., Wicklund H., Unsgaard B., Baldetorp L., Ahlström S., Fosså S. D. Prognostic factors in unselected patients with nonseminomatous metastatic testicular cancer: a multicenter experience. J Clin Oncol. 1991 May;9(5):818–826. doi: 10.1200/JCO.1991.9.5.818. [DOI] [PubMed] [Google Scholar]
  2. Bajorin D. F., Motzer R. J., Rodriguez E., Murphy B., Bosl G. J. Acute nonlymphocytic leukemia in germ cell tumor patients treated with etoposide-containing chemotherapy. J Natl Cancer Inst. 1993 Jan 6;85(1):60–62. doi: 10.1093/jnci/85.1.60. [DOI] [PubMed] [Google Scholar]
  3. Baniel J., Foster R. S., Gonin R., Messemer J. E., Donohue J. P., Einhorn L. H. Late relapse of testicular cancer. J Clin Oncol. 1995 May;13(5):1170–1176. doi: 10.1200/JCO.1995.13.5.1170. [DOI] [PubMed] [Google Scholar]
  4. Bokemeyer C., Schmoll H. J., Kuczyk M. A., Beyer J., Siegert W. Risk of secondary leukemia following high cumulative doses of etoposide during chemotherapy for testicular cancer. J Natl Cancer Inst. 1995 Jan 4;87(1):58–60. doi: 10.1093/jnci/87.1.58. [DOI] [PubMed] [Google Scholar]
  5. Boshoff C., Begent R. H., Oliver R. T., Rustin G. J., Newlands E. S., Andrews R., Skelton M., Holden L., Ong J. Secondary tumours following etoposide containing therapy for germ cell cancer. Ann Oncol. 1995 Jan;6(1):35–40. doi: 10.1093/oxfordjournals.annonc.a059037. [DOI] [PubMed] [Google Scholar]
  6. Dearnaley D. P., Horwich A., A'Hern R., Nicholls J., Jay G., Hendry W. F., Peckham M. J. Combination chemotherapy with bleomycin, etoposide and cisplatin (BEP) for metastatic testicular teratoma: long-term follow-up. Eur J Cancer. 1991;27(6):684–691. doi: 10.1016/0277-5379(91)90166-b. [DOI] [PubMed] [Google Scholar]
  7. Einhorn L. H., Donohue J. Cis-diamminedichloroplatinum, vinblastine, and bleomycin combination chemotherapy in disseminated testicular cancer. Ann Intern Med. 1977 Sep;87(3):293–298. doi: 10.7326/0003-4819-87-3-293. [DOI] [PubMed] [Google Scholar]
  8. Einhorn L. H. Have new aggressive chemotherapy regimens improved results in advanced germ cell tumors? Eur J Cancer Clin Oncol. 1986 Nov;22(11):1289–1293. doi: 10.1016/0277-5379(86)90135-5. [DOI] [PubMed] [Google Scholar]
  9. Feuer E. J., Frey C. M., Brawley O. W., Nayfield S. G., Cunningham J. B., Geller N. L., Bosl G. J., Kramer B. S. After a treatment breakthrough: a comparison of trial and population-based data for advanced testicular cancer. J Clin Oncol. 1994 Feb;12(2):368–377. doi: 10.1200/JCO.1994.12.2.368. [DOI] [PubMed] [Google Scholar]
  10. Fosså S. D., Aass N. Cisplatin-based chemotherapy does not eliminate the risk of a second testicular cancer. Br J Urol. 1989 May;63(5):531–534. doi: 10.1111/j.1464-410x.1989.tb05951.x. [DOI] [PubMed] [Google Scholar]
  11. Gerl A., Clemm C., Hentrich M., Hartenstein R., Wilmanns W. Etoposide, cisplatin, bleomycin, and cyclophosphamide (ECBC) as first-line chemotherapy for poor-risk non-seminomatous germ cell tumors. Acta Oncol. 1993;32(5):541–546. doi: 10.3109/02841869309096115. [DOI] [PubMed] [Google Scholar]
  12. Gerl A., Clemm C., Schmeller N., Dienemann H., Lamerz R., Kriegmair M., Wilmanns W. Outcome analysis after post-chemotherapy surgery in patients with non-seminomatous germ cell tumours. Ann Oncol. 1995 May;6(5):483–488. doi: 10.1093/oxfordjournals.annonc.a059219. [DOI] [PubMed] [Google Scholar]
  13. Gerl A., Clemm C., Schmeller N., Dienemann H., Weiss M., Kriegmair M., Löhrs U., Wilmanns W. Sequential resection of residual abdominal and thoracic masses after chemotherapy for metastatic non-seminomatous germ cell tumours. Br J Cancer. 1994 Nov;70(5):960–965. doi: 10.1038/bjc.1994.429. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Gerl A., Clemm C., Schmeller N., Hartenstein R., Lamerz R., Wilmanns W. Prognosis after salvage treatment for unselected male patients with germ cell tumours. Br J Cancer. 1995 Oct;72(4):1026–1032. doi: 10.1038/bjc.1995.456. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Gerl A. Vascular toxicity associated with chemotherapy for testicular cancer. Anticancer Drugs. 1994 Dec;5(6):607–614. doi: 10.1097/00001813-199412000-00001. [DOI] [PubMed] [Google Scholar]
  16. Harding M. J., Paul J., Gillis C. R., Kaye S. B. Management of malignant teratoma: does referral to a specialist unit matter? Lancet. 1993 Apr 17;341(8851):999–1002. doi: 10.1016/0140-6736(93)91082-w. [DOI] [PubMed] [Google Scholar]
  17. Hatton M. Q., Paul J., Harding M., MacFarlane G., Robertson A. G., Kaye S. B. Changes in the incidence and mortality of testicular cancer in Scotland with particular reference to the outcome of older patients treated for non-seminomatous germ cell tumours. Eur J Cancer. 1995;31A(9):1487–1491. doi: 10.1016/0959-8049(95)00298-w. [DOI] [PubMed] [Google Scholar]
  18. Hitchins R. N., Newlands E. S., Smith D. B., Begent R. H., Rustin G. J., Bagshawe K. D. Long-term outcome in patients with germ cell tumours treated with POMB/ACE chemotherapy: comparison of commonly used classification systems of good and poor prognosis. Br J Cancer. 1989 Feb;59(2):236–242. doi: 10.1038/bjc.1989.48. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Horwich A. Germ cell tumour chemotherapy. Br J Cancer. 1989 Feb;59(2):156–159. doi: 10.1038/bjc.1989.33. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Howard G. C., Clarke K., Elia M. H., Hutcheon A. W., Kaye S. B., Windsor P. M., Yosef H. M., Sharp L. A Scottish national mortality study assessing cause of death, quality of and variation in management of patients with testicular non-seminomatous germ-cell tumours. The Scottish Radiological Society and the Scottish Standing Committee of the Royal College of Radiologists. Br J Cancer. 1995 Nov;72(5):1307–1311. doi: 10.1038/bjc.1995.506. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. MANTEL N., HAENSZEL W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959 Apr;22(4):719–748. [PubMed] [Google Scholar]
  22. Mead G. M., Stenning S. P., Parkinson M. C., Horwich A., Fossa S. D., Wilkinson P. M., Kaye S. B., Newlands E. S., Cook P. A. The Second Medical Research Council study of prognostic factors in nonseminomatous germ cell tumors. Medical Research Council Testicular Tumour Working Party. J Clin Oncol. 1992 Jan;10(1):85–94. doi: 10.1200/JCO.1992.10.1.85. [DOI] [PubMed] [Google Scholar]
  23. Nichols C. R., Breeden E. S., Loehrer P. J., Williams S. D., Einhorn L. H. Secondary leukemia associated with a conventional dose of etoposide: review of serial germ cell tumor protocols. J Natl Cancer Inst. 1993 Jan 6;85(1):36–40. doi: 10.1093/jnci/85.1.36. [DOI] [PubMed] [Google Scholar]
  24. Pedersen-Bjergaard J., Daugaard G., Hansen S. W., Philip P., Larsen S. O., Rørth M. Increased risk of myelodysplasia and leukaemia after etoposide, cisplatin, and bleomycin for germ-cell tumours. Lancet. 1991 Aug 10;338(8763):359–363. doi: 10.1016/0140-6736(91)90490-g. [DOI] [PubMed] [Google Scholar]
  25. Stiller C. A. Centralised treatment, entry to trials and survival. Br J Cancer. 1994 Aug;70(2):352–362. doi: 10.1038/bjc.1994.306. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Tibshirani R. A plain man's guide to the proportional hazards model. Clin Invest Med. 1982;5(1):63–68. [PubMed] [Google Scholar]
  27. Williams S. D., Birch R., Einhorn L. H., Irwin L., Greco F. A., Loehrer P. J. Treatment of disseminated germ-cell tumors with cisplatin, bleomycin, and either vinblastine or etoposide. N Engl J Med. 1987 Jun 4;316(23):1435–1440. doi: 10.1056/NEJM198706043162302. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK

RESOURCES