Etoposide and cisplatin adjuvant therapy for patients with pathologic stage II germ cell tumors Journal Article

Authors: Motzer, R. J.; Sheinfeld, J.; Mazumdar, M.; Bajorin, D. F.; Bosl, G. J.; Herr, H.; Lyn, P.; Vlamis, V.
Article Title: Etoposide and cisplatin adjuvant therapy for patients with pathologic stage II germ cell tumors
Abstract: Purpose: Two options cure nearly all patients with pathologic stage II nonseminomatous germ cell tumors (NSGCTs): two cycles of adjuvant chemotherapy with cisplatin, vinblastine, and bleomycin (PVB) or cisplatin, vinblastine, bleomycin, cyclophosphamide, and dactinomycin (VAB-6); or close observation with full treatment at relapse. Two cycles of etoposide plus cisplatin (EP) were given to selected patients with pathologic stage II NSGCT and high-volume nodal metastases. Patients and Methods: All patients had pathologic stage II NSGCT with one or more of the following features found at retroperitoneal lymph node dissection (RPLND), suggesting a greater than 50% likelihood of relapse after observation alone: (1) any lymph node involved by tumor greater than 2 cm (stage N2b); (2) ≥ six nodes involved with tumor (stage N2b); and (3) extranodal extension (stage N3). Two cycles of therapy were given at 21-day intervals; each cycle consisted of etoposide 100 mg/m2 plus cisplatin 20 mg/m2 per day given on days 1 to 5. Results: Fifty patients were treated with two cycles of EP. Treatment was well tolerated; five patients (10%) were admitted for nadir fever and none had grade II or greater neurologic, renal, or pulmonary toxicity. All 50 patients are alive and relapse-free at a median follow-up time of 35 months (range, 12 to 72). The follow-up duration has been ≥ 2 years for 42 patients. Conclusion: A treatment program that consists of two cycles of EP is effective in preventing relapses in patients with completely resected pathologic stage N2b and N3 NSGCT. The likelihood of relapse without adjuvant cisplatin-containing chemotherapy in this group has been shown to be greater than 50%. As has been demonstrated in patients with disseminated germ cell tumor (GCT), EP can be considered a therapeutic option in the adjuvant setting for completely resected N2b and N3 NSGCT.
Keywords: adolescent; adult; human tissue; treatment outcome; human cell; major clinical study; clinical trial; histopathology; paresthesia; cisplatin; cancer combination chemotherapy; treatment planning; cancer staging; antineoplastic agent; lymph node dissection; etoposide; nausea; stomatitis; vomiting; tinnitus; relapse; cyclophosphamide; vinblastine; fever; dactinomycin; bleomycin; alopecia; germ cell tumor; human; male; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 13
Issue: 11
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 1995-11-01
Start Page: 2700
End Page: 2704
Language: English
DOI: 10.1200/jco.1995.13.11.2700
PUBMED: 7595727
PROVIDER: scopus
Notes: Article -- Export Date: 28 August 2018 -- Source: Scopus
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MSK Authors
  1. Dean Bajorin
    416 Bajorin
  2. Robert Motzer
    769 Motzer
  3. Madhu Mazumdar
    125 Mazumdar
  4. Joel Sheinfeld
    197 Sheinfeld
  5. Harry W Herr
    407 Herr
  6. George Bosl
    270 Bosl
  7. Vaia   Vlamis
    29 Vlamis