PREDICTORS OF OVERALL SURVIVAL IN PATIENTS WITH RECURRENT NON-SEMINOMATOUS GERMINAL TESTICULAR TUMORS ON CURRENT SECOND-LINE CHEMOTHERAPY

Objective: to define predictors that influence longevity in patients with recurrent non-seminomatous germinal testicular tumors (NGTT) on standard second-line chemotherapy (CT) including cisplatin and iphosphamide. Statistical analysis was performed using the statistical packages Graph Pad Prism 4.00 for Windows and SPSS 15.0 for Windows. Subjects and methods. Case history data were analyzed in 693 patients with disseminated NGTT who had received current CT and followed up at the Department of Clinical Pharmacology and CT, N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences. The median follow-up was 32 (range 3-215) months. The disease progressed in 181 (26%) patients. Detailed information was available on the nature of second-line CT in only 138 patients. Half (71 (51.7%) of the 138 patients had second-line CT including iphosphamide. Uni- and multivariate analyses were made to identify predictors that influence longevity in patients with recurrent NGTT on standard secondline CT including cisplatin and iphosphamide. Results. Five-year overall survival (OS) was 32% (95% confidence interval 25-41%). The multivariate analysis showed the morphological pattern of a primary tumor (a yolk sac tumor component), a pre-induction CT lactate dehydrogenase (LDH) level of ?d1.5 units of the upper normal range, progression during induction CT, and a pre-second-line CT LDH level of ?d 1000 U/l to be negative predictors. According to the number of negative factors, the patients were classified into 3 groups: 1) good prognosis [n = 10 (14%) of the 71 patients], 100% 3-year OS; 2) intermediate prognosis (one negative factor) [n = 33 (46.5%) of the 71 patients], 50.2% 3-year OS; 3) poor prognosis (?d 2 negative factors), 6.7% 3-year OS. Conclusion. Standard iphosphamide-containing therapy enables all patients to be treated in the good prognosis group of those with recurrent NGTT. That fails to achieve such striking results in the intermediate and poor prognosis groups of patients with recurrent NGTT, which necessiates to search for new treatment regimens and approaches for these patient groups.

germinal testicular tumors, recurrences, chemotherapy, predictors

1. Трякин А.А., Буланов А.А.,Тюляндин С.А. Индукционная химиоте-рапия метастатических герминогенных опухолей. Практ онкол 2006;7(1):30-8.

2. Тюляндин С.А. Лечение диссеминиро-ванных герминогенных опухолей у муж-чин. В сб.: Материалы VI Российской он-кологической конференции 26-28 ноя-бря 2002 г. М., 2002.

3. Motzer R.J., Sheinfeld J., Mazumdar M. et al. Paclitaxel, ifosfamide, and cisplatin second-line therapy for patients with relapsed testicular germ cell cancer. J Clin Oncol 2000;18(12):2413-8.

4. Bhatia S., Abomow R., Porcu P. et al. High-dose chemotherapy as initial salvage chemotherapy in patients with relapsed testicular cancer. J Clin Oncol 2000;18:3346-51.

5. Broun E.R., Nichols C.R., Kneebone P. et al. Long-term outcome of patients with relapsed and refractory germ cell tumors treated with high-dose chemotherapy and autologous bone marrow rescue. Ann Intern Med 1992;117(2):124-8.

6. Siegert W., Beyer J., Strohscheer I. et al. High-dose treatment with carboplatin, etoposide, and ifosfamide followed by autologous stem-cell transplantation in relapsed or refractory germ cell cancer: a phase I/II study. The German Testicular Cancer Cooperative Study Group. J Clin Oncol 1994;12(6):1223-31.

7. Kondagunta G., Bacik J., Sheinfeld J. et al. Paclitaxel plus ifosfamide followed by high-dose carboplatin plus etoposide in previously treated germ cell tumors. J Clin Oncol 2007;25:85-90.

8. Loehrer P.J., Gonin R., Nichols C.R. et al. Vinblastine plus ifosfamide plus cisplatin as initial salvage therapy in recurrent germ cell tumor. J Clin Oncol 1998;16:2500-4.

9. Fossa S.D., Stenning S.P., Gerl A. et al. Prognostic factors in patients progressing after cisplatin-based chemotherapy for malignant non-seminomatous germ cell tumours. Br J Cancer 1999;80(9):1392-9.

10. Beyer J., Kramar A., Mandanas R. et al. High-dose chemotherapy as salvage treatment in germ cell tumors. A multivariate analysis of prognostic variables. J Clin Oncol 1996;14:2638-45.

11. Vaena D.A., Abonour R., Einhorn L.H. Long-term survival after high-dose salvage chemotherapy for germ cell malignancies with adverse prognostic variables. Proc Am Soc Clin Oncol 2003. Abstr 1538.