Cisplatin-etoposide and carboplatin-etoposide induction chemotherapy for good-risk patients with germ cell tumor

Tjulandin, S.; Garin, A.; Mescheryakov, A. A.; Переводчикова, Н И; Gorbunova, Vera; Соколов, А. В.; Ljubimova, N. V.; Mironova, G. T.; Molchanov, G. V.; Ozols, Robert F.; Hamilton, J. Michael

doi:10.1093/oxfordjournals.annonc.a058621

Cited by 22 publications

(7 citation statements)

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“…Grade IV neutropenia occurred in 36% of treatment cycles, thus was similar to the degree of neutropenia in the study of Horwich et al [10]. Grade III or IV thrombocytopenia in our study occurred in 16% as compared to 17% in the study of Horwich et al and 0% in another study using etoposide and carboplatin alone, where an insufficient dose of carboplatin was used [12]. …”

Section: Discussionsupporting

confidence: 87%

“…In 1989 Horwich et al reported on the effectiveness of carboplatin alone in seminomatous germ cell tumors [9]and in 1991 the same authors reported on the tolerance and favorable outcome of four cycles of carboplatin, etoposide and bleomycin (CEB 90 regimen) in low-risk nonseminomatous germ cell tumors [10]. Two years later it became evident that carboplatin was inferior to cisplatin; however, in both randomized studies bleomycin was omitted and treatments were given at intervals of 4 weeks [11, 12]. Because of the results published by Horwich and colleagues [7], we decided in 1991 to develop a treatment protocol of CEB 90 for patients with low-risk tumors, defined as seminomatous disease and/or nonseminomatous disease with a tumor mass <10 cm, less than 20 lung metastases, no liver, bone or CNS metastases, and levels of AFP <1,000 IU/ml and βHCG <10,000 IU/l, a slight modification of the MRC classification.…”

Section: Introductionmentioning

confidence: 99%

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Risk-Adapted Chemotherapy of Germ Cell Tumors with Carboplatin, Etoposide and Bleomycin for Low-Risk and Cisplatin, Etoposide and Ifosfamide for High-Risk Patients

Tscherry

Jacky²,

Jost³

et al. 2000

Oncology

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The prognosis of germ cell tumors treated with chemotherapy depends on the presence of nonseminomatous tumor, clinical parameters based on the tumor volume and site, as well as on the level of the tumor markers AFP, βHCG and LDH. We report here on the results of a risk-adapted approach to the chemotherapy of germ cell tumors. Patients with low-risk tumors, defined as seminomatous disease and/or nonseminomatous disease with a tumor mass <10 cm, less than 20 lung metastases, no liver, bone, or CNS metastases, and levels of AFP <1,000 IU/ml and βHCG <10,000 IU/l, were to receive 4 cycles of carboplatin 400 mg/m² i.v. day 1, etoposide 120 mg/m² i.v. days 1–3 and bleomycin 30 IU i.v. days 1, 8 and 15 during the first 3 cycles (CEB₉₀). Patients with high-risk disease were to receive 4 cycles of ifosfamide 1,500 mg/m² continuous infusion on days 1–4 together with mesna 1,200 mg/m² days 1–5, cisplatin 20 mg/m² i.v. days 1–5 and etoposide 100 mg/m² i.v. days 1–5 (VIP). Of the 60 patients treated with this risk-adapted approach, 51 had low-risk and 9 had high-risk disease. Forty-five of 51 patiens treated with CEB₉₀ achieved complete remission (CR), 4 achieved partial remission with marker negativity. Four patients with CR relapsed between 4 to 8 months after the start of chemotherapy. Of the 6 patients failing CEB₉₀, 3 were treated successfully with surgery or further chemotherapy. With a median follow-up of 52 months, the estimated cause-specific 3-year survival is 93% (95% confidence interval, CI, 80–98%). Seven of 9 high-risk patients treated with VIP achieved a CR and 1 patient relapsed. All 3 patients failing VIP had successful salvage therapy. With a medium follow-up of 63 months all patients remain alive and free of disease. Forty-six patients receiving CEB₉₀ were retrospectively classified to be in the good prognosis group according to the international germ cell consensus classification. Their estimated 3-year survival was 95% (CI 81–99%). We thus confirm that CEB₉₀ is a well-tolerated outpatient regimen with good results in good prognosis germ cell tumors. Bleomycin at a cumulative dose of 270 U might contribute substantially to the inferior effect of carboplatin as compared to cisplatin. However, in view of the results of randomized studies favoring cisplatin over carboplatin, it is not recommended to use this regimen outside a clinical trial.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Risk-Adapted Chemotherapy of Germ Cell Tumors with Carboplatin, Etoposide and Bleomycin for Low-Risk and Cisplatin, Etoposide and Ifosfamide for High-Risk Patients

Tscherry

Jacky²,

Jost³

et al. 2000

Oncology

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“…Despite its more favourable toxicity profile, carboplatin should not be routinely used in the treatment of testicular GCTs. Several randomized trials have demonstrated an inferior outcome with carboplatin [12][13][14]. Another approach that has been used with some success is to hydrate the patients during cisplatin treatment.…”

Section: Discussionmentioning

confidence: 99%

Cisplatin Nephrotoxicity in A Patient With Metastatic Testicular Choriocarcinoma: A Case Report and Review of the Literature

Monleón¹,

Barrallo²,

González³

2017

J Nephrol Kidney Dis

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Choriocarcinoma is an aggressive and uncommon germ cell testicular tumour which represents only 1 to 3% of all germ cell testicular tumours. It is a tumour that has a propensity for early haematogenous dissemination, which is why it often presents itself as a disseminated disease at diagnosis. In the advanced stages of the disease, treatment must be systemic, and for this there are different chemotherapy regimens. All treatment regimens contain platinum as a fundamental chemotherapeutic agent in this type of tumours. One of the most frequent adverse effects in these treatment regimens is cisplatin nephrotoxicity. The case report presents a 28 year old man with metastatic testicular choriocarcinoma treated with platinum-based chemotherapy that presented nephrotoxicity as an adverse effect, making treatment with cisplatin impossible. Despite using the corresponding support measures for this type of situations, the recovery of renal function was prolonged up to several weeks. During this time of recovery, it was not possible to continue with the chemotherapeutic treatment. As a result, since it was an aggressive disease, the disease progression led to the death of the patient due to multiple organ failure. This case report is intended to emphasize the importance of monitoring renal function to ensure adequate dosing of chemotherapeutic agents and the early detection of nephrotoxicity.

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“…In adult men with testicular cancer, five randomized trials reported superiority of cisplatin over carboplatin. [43][44][45][46][47] Is important to note two major differences between the adult and pediatric carboplatin-based regimens. First, in pediatric trials, the dose-intensity (individual dose and number of cycles) was significantly higher when compared with adult trials, and second, the risk stratification between pediatric and adult patients (and therefore the treatment intensity) was not comparable.…”

Section: Treatment Differences Across Age Groupsmentioning

confidence: 99%

Germ Cell Tumors in Adolescents and Young Adults

Fonseca

Frazier

Shaikh

2019

JOP

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Germ cell tumors (GCTs) are rare in childhood, representing only 3.5% of childhood cancers, but a common malignancy in adolescents and young adults (AYAs), accounting for 13.9% of neoplasms in adolescents between age 15 and 19 years. The overall outcomes of patients treated for GCTs are excellent. However, as seen in other cancers, outcomes for AYA patients are significantly worse. Understanding the reasons for this observation has led to different approaches to diagnosis, staging, and treatment. The Malignant Germ Cell International Consortium was created to bring together pediatric, gynecologic, and testicular cancer specialists to promote research initiatives and provide evidence-based approaches in the management of GCTs across different age groups. Collaboration between multiple subspecialties is essential to further understand the disease continuum, the underlying biologic characteristics, and the development of appropriate therapeutic approaches. This review focuses on the unique characteristics of patients with extracranial GCTs in the AYA group.

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Cisplatin-etoposide and carboplatin-etoposide induction chemotherapy for good-risk patients with germ cell tumor

Abstract: The study suggests that carboplatin-etoposide combination therapy is inferior to cisplatin-etoposide in patients with good-risk germ cell tumors.

Cited by 22 publications

References 5 publications

Risk-Adapted Chemotherapy of Germ Cell Tumors with Carboplatin, Etoposide and Bleomycin for Low-Risk and Cisplatin, Etoposide and Ifosfamide for High-Risk Patients

Risk-Adapted Chemotherapy of Germ Cell Tumors with Carboplatin, Etoposide and Bleomycin for Low-Risk and Cisplatin, Etoposide and Ifosfamide for High-Risk Patients

Cisplatin Nephrotoxicity in A Patient With Metastatic Testicular Choriocarcinoma: A Case Report and Review of the Literature

Germ Cell Tumors in Adolescents and Young Adults

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