Clinical features, presentation, and tolerance of platinum‐based chemotherapy in germ cell tumor patients 50 years of age and older

Abstract

BACKGROUND: Germ cell tumors (GCTs) primarily affect adolescent and young adult men. Detailed clinical and treatment characteristics in older men are lacking. METHODS: Patients with GCT seen over a 20-year period at Memorial Sloan-Kettering Cancer Center were identified. Primary tumor site and histology were compared for patients aged 50 years at diagnosis versus younger men. For patients aged 50, individual chart review was performed and treatment delays, changes, and toxicities were recorded for those treated with first-line chemotherapy. RESULTS: Of 4235 diagnoses of GCT, 3999 (94.4%) were made at age < 50 versus 236 (5.6%) at age 50. Compared with patients diagnosed before age 50, older men more frequently had seminoma (62.7% versus 36.7%) and less frequently, nonseminoma (34.7% versus 63.2%) (P <.0001). Predominant histology switched from nonseminoma to seminoma around age 35. Distribution of primary sites also differed for older versus younger men (testis: 89.4% versus 92.9%; retroperitoneal: 3.8% versus 0.7%; CNS 0% versus 1.7%) except for mediastinal primary tumors, which remained constant across age groups. Fifty patients age 50 received first-line platinum-based chemotherapy; 30 experienced complications leading to treatment discontinuation, delay 7 days, or regimen change. Twenty-two (44%) patients experienced neutropenic fever, 6 despite prophylactic growth factor support. Estimated 5-year survival for chemotherapy-treated patients was 84.9%. CONCLUSIONS: Men aged 50 years comprise less than 10% of GCT diagnoses and have distinct clinical and histological characteristics as compared with younger patients. Although complications from chemotherapy occur frequently in older men, prognosis remains excellent when risk-directed treatment is administered with curative intent. Cancer 2013;119:2574-81. V C 2013 American Cancer Society.KEYWORDS: germ cell tumors; testicular cancer; age over 50; epidemiology; histology; primary site; cisplatin. INTRODUCTIONGerm cell tumors (GCTs) primarily affect adolescent and young adult men, with diagnoses in older patients, children, and women occurring much less commonly. In men, most GCTs arise in the testis but extragonadal primary tumor sites comprise up to 10% of cases, typically in midline locations such as the mediastinum, retroperitoneum, or pineal gland. The World Health Organization classification of tumors 1 categorizes GCTs in adolescents and adults into 3 histologic groups: classic seminoma with pure histology; nonseminomatous GCT (NSGCT), comprising embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma, and mixed histologies (which can include seminoma); and spermatocytic seminoma.2 In most epidemiological studies, rates of seminoma slightly exceed those of NSGCT, 3,4 with spermatocytic seminoma comprising < 1% of cases. The incidence of seminoma and NSGCT differs across age groups, peaking between ages 35 and 39 years for seminoma compared with 25 to 29 years for NSGCT. 4 Nevertheless, both histologic types are rare in older men with fewer than 10% a...

Survival and toxicity in patients with disseminated germ cell cancer aged 40 years and older

“…7,[18][19][20][21] In 2 recent studies, toxicity related to the treatment of GCC was examined in patients aged 50 years. 22,23 Both of those studies reported that all chemotherapy-related toxicities were manageable, and a general chemotherapy dose reduction in elderly patients has not been recommended. 24 Our study supports this finding.…”

Surveillance des séminomes testiculaires de stade I : résultats oncologiques sur 20ans

“…Enfin, pour les patients sous surveillance, le taux de rechute à 10 ans varie de 6,6 % à 19 % mais avec une survie spécifique à 10 ans après traitement de rattrapage de 98,7 % à 100 % [13]. La survie globale atteint elle 98,4 % à 10 ans [14]. Ces résultats sont superposables à ceux retrouvés dans notre étude avec des survies spécifique et globale à 2, 5 et 8 ans de 97,4 %.…”

“…Pour la chimiothéra-pie, les complications aiguës semblent ainsi majorées chez les patients de plus de 50 ans. Jusqu'à 60 % des patients peuvent ne pas accomplir l'ensemble de la chimiothérapie ou du moins avoir un retard d'administration [14]. Bien que les patients plus âgés doivent théoriquement tirer les mêmes bénéfices de la chimiothérapie que les patients jeunes, il est clairement démontré que les altérations des grandes fonctions et/ou les comorbidités liées à l'âge peuvent affecter les résultats et augmenter les effets secondaires [14].…”

Systemic management of malignant ovarian germ cell tumors in older women: two case reports and a review of the literature

“…In 60% of patients, complications led to treatment discontinuation, change in regimen or significant delay. In the case of BEP, 72% of patients changed to alternate regimens, predominantly due to worsening pulmonary function and thromboembolic complications; the rate of neutropenic fever per cycle was 24% in patients treated with this regimen [84]. In another study by Thomsen et al, 135 patients aged ≥40 years with disseminated germ-cell cancer treated with BEP were compared with a control group of younger patients.…”