Four cycles of etoposide plus cisplatin for patients with good-risk advanced germ cell tumors Journal Article


Authors: Funt, S. A.; McHugh, D. J.; Tsai, S.; Knezevic, A.; O'Donnell, D.; Patil, S.; Silber, D.; Bromberg, M.; Carousso, M.; Reuter, V. E.; Carver, B. S.; Sheinfeld, J.; Motzer, R. J.; Bajorin, D. F.; Bosl, G. J.; Feldman, D. R.
Article Title: Four cycles of etoposide plus cisplatin for patients with good-risk advanced germ cell tumors
Abstract: Background: The National Comprehensive Cancer Network recommends either three cycles of bleomycin, etoposide, and cisplatin or four cycles of etoposide and cisplatin (EPx4) as initial chemotherapy for the treatment of good-risk germ cell tumors (GCTs). To assess the response, toxicity, and survival outcomes of EPx4, we analyzed our experience. Material and Methods: Response and survival outcomes, selected toxicities, and adherence to chemotherapy dose and schedule were assessed in patients with good-risk GCT who received EPx4 at Memorial Sloan Kettering Cancer Center between 1982 and 2016. The results were compared with our past results and published data. Results: Between 1982 and 2016, 944 patients with GCT were treated with EPx4, 289 who were previously reported plus 655 treated between January 2000 and August 2016. A favorable response was achieved in 928 of 944 patients (98.3%). Five-year progression-free, disease-specific, and overall survival rates were 93.9%, 98.6%, and 97.9%, respectively. Median follow-up was 7.3 years (range, 2.8 months to 35.5 years). Viable, nonteratomatous malignant GCT was present in 3.5% of 432 postchemotherapy retroperitoneal lymph node dissection specimens from patients with nonseminomatous GCT. Febrile neutropenia and thromboembolic events occurred in 16.0% and 8.9%, respectively, with one treatment-related death. In the more recent 655-patient cohort, full-dose EPx4 was administered to 631 (96.3%), with deviations from planned treatment driven mainly by vascular (n = 13), hematologic (n = 11), renal (n = 7), or infectious (n = 5) events. Conclusion: EPx4 is highly effective and well tolerated in patients with good-risk GCTs and remains a standard of care. Implications for Practice: Four cycles of etoposide and cisplatin (EPx4) is a standard-of-care regimen for all patients with good-risk germ cell tumors with a favorable response rate and disease-specific survival of 98%. Full-dose administration of etoposide and cisplatin and complete resection of residual disease lead to optimal outcomes. EPx4 should be the recommended regimen in active smokers, patients with reduced or borderline kidney function, and patients aged 50 years or older, which are patient groups at increased risk for bleomycin pulmonary toxicity. Because of a risk of acquired severe pulmonary illness, EPx4 may also be favored for patients who vape or use e-cigarettes and during ongoing transmission of severe acute respiratory syndrome coronavirus 2. © 2021 AlphaMed Press
Keywords: cisplatin; antineoplastic agent; neoplasm; etoposide; antineoplastic combined chemotherapy protocols; testis tumor; testicular neoplasms; bleomycin; neoplasms, germ cell and embryonal; germ cell tumor; standard of care; humans; human; male; electronic cigarette; covid-19; sars-cov-2; electronic nicotine delivery systems
Journal Title: The Oncologist
Volume: 26
Issue: 6
ISSN: 1083-7159
Publisher: AlphaMed Press  
Date Published: 2021-06-01
Start Page: 483
End Page: 491
Language: English
DOI: 10.1002/onco.13719
PUBMED: 33586274
PROVIDER: scopus
PMCID: PMC8176973
DOI/URL:
Notes: Article -- Export Date: 1 July 2021 -- Source: Scopus
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Citation Impact
MSK Authors
  1. Sujata Patil
    486 Patil
  2. Dean Bajorin
    575 Bajorin
  3. Robert Motzer
    1022 Motzer
  4. Darren Richard Feldman
    255 Feldman
  5. Joel Sheinfeld
    240 Sheinfeld
  6. Brett Stewart Carver
    131 Carver
  7. Victor Reuter
    1129 Reuter
  8. George Bosl
    403 Bosl
  9. Samuel Aaron Funt
    73 Funt
  10. Deaglan Joseph McHugh
    17 McHugh
  11. Deborah Scaler Silber
    8 Silber
  12. Stephanie Tsai
    5 Tsai