Comparison of two standard chemotherapy regimens for good-prognosis germ-cell tumours: a randomised trial

Toner, Guy C.; Stockler,; Boyer, Michael; Jones, Michael P.; Thomson, D. B.; Harvey, VJ; Olver, I.; Dhillon, Haryana M.; McMullen, Amanda; Gebski, V.; Levi, J A; Simes, R. John

doi:10.1016/s0140-6736(00)04165-9

Cited by 113 publications

(48 citation statements)

References 22 publications

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“…Although the difference was not significant, there was a trend toward higher GCC mortality in patients aged 40 years who received reduced doses of bleomycin in the current study, in agreement with previous studies, which demonstrated that bleomycin was an important part of GCC treatment, because both disease-free and overall survival were superior when bleomycin was part of the treatment. 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.…”

Section: Discussionmentioning

confidence: 99%

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

Thomsen

Bandak

Thomsen

et al. 2013

Cancer

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BACKGROUND: Germ-cell cancer (GCC) patients aged 40 years have a two-fold higher GCC-specific mortality. It has been hypothesized that reduced treatment intensity combined with increased treatment related toxicity could be the explanation. The objective was to analyze chemotherapy intensity, treatment related toxicity and survival in patients aged 40 years treated with standard chemotherapy for GCC compared with a younger control group that received similar treatment during the same period. METHODS: From 1984 to 2011, 135 patients aged 40 years with disseminated GCC treated with bleomycin, etoposide and cisplatin (BEP). A control-group of 135 patients aged 18-35 years was randomly selected matched on year of BEP treatment. Cumulated doses of BEP as well as bone marrow toxicity, renal-and lung functions were recorded before, during and after termination of treatment. All patients were followed until death or October 1, 2011. RESULTS: The cumulated doses of BEP were comparable between the two groups, however, more patients aged 40 years were reduced in bleomycin doses based on a decrease in carbon monoxide diffusion capacity corrected for haemoglobin (P 5 0.03). No differences between the two groups were found regarding bone marrow toxicity or mean percentage changes in lung-or renal function. Patients aged 40 year had increased cancer specific mortality, HR 5 4.8 (P 5 0.005). In particular patients with disease progression after first line chemotherapy had increased mortality (P 5 0.015). Moreover, the 5-year overall survival for patients aged 40 years was 82.5% compared to the expected 5-year survival of the background population of 96.3% (P <0.001). CONCLUSIONS: Treatment related toxicity could not explain the increased cancer specific mortality in patients aged 40 years compared to a younger control-group, and while there were no differences in the administrated doses of cisplatin/ etoposide, a decreased number of bleomycin doses were administered in the older patients. Apart from this, the inferior prognosis could be related to tumour biology, increased co-morbidity, or more severe toxicity in relation to second line treatment. Cancer 2014;120:43-51.

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Section: Discussionmentioning

confidence: 99%

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

Thomsen

Bandak

Thomsen

et al. 2013

Cancer

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“…97,98,104,105 If there is a contraindication to bleomycin, 4 cycles of EP can be given, but has been associated with a nonstatistically significant but higher death rate in one RCT. 100,106,107 …”

Section: Treatment Of Advanced or Metastatic Diseasementioning

confidence: 99%

Canadian consensus guidelines for the management of testicular germ cell cancer

Wood

Kollmannsberger

Jewett

et al. 2013

CUAJ

123

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“…Important improvements have recently been achieved in the management of these diseases. After radical orchidectomy, the adjuvant treatment for testicular cancer differs according to the tumor's histology (3)(4)(5)(6). Approximately 95% of malignant tumors arising in the testis are germ-cell tumors and are classified as seminomatous or nonseminomatous (7,8).…”

Section: Introductionmentioning

confidence: 99%

No Long-Term Increase in Sperm Aneuploidy Rates after Anticancer Therapy

Thomas

Cans

Pelletier

et al. 2004

Clinical Cancer Research

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Purpose: Lymphomas and testicular cancers are the most frequent malignancies among young men. With recent improvement of survival rates, for many patients, the question is raised of the consequences of the anticancer treatments on their fertility and more specifically of a potential genetic risk for the offspring. This article presents the study of sperm aneuploidy rates in the largest population of cancer-treated patients studied thus far.Experimental Design: In the present study, 38 patients were initially included 7 months to 5 years after a cancer treatment by chemotherapy and/or radiotherapy for testicular cancer (n ‫؍‬ 19) or lymphoma (n ‫؍‬ 19). Twelve of them were azoospermic. Sperm aneuploidy rates of chromosomes X, Y, 13, 18, and 21 were analyzed by multicolor fluorescent in situ hybridization in the 26 other patients.Results: In most cases, the disomy/diploidy rates after cancer therapy did not significantly differ from those observed in the group of control healthy donors. Only five patients (one lymphoma and four testicular cancer) showed significant but still moderate increases in disomic and/or diploid sperm. For the lymphoma patient, the short posttherapeutic delay after the treatment could explain the elevated aneuploidy rates, whereas no risk factor in the clinical, biological, or therapeutic records could be identified in any of the four testicular cancer patients with elevated sperm aneuploidy rates.Conclusions: These data suggest an absence of longterm effect of anticancer therapy on sperm aneuploidy rates, and therefore, no long-term increased risk of aneuploidy for the offspring obtained either spontaneously or after assisted reproductive techniques.

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Comparison of two standard chemotherapy regimens for good-prognosis germ-cell tumours: a randomised trial

Cited by 113 publications

References 22 publications

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

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

Canadian consensus guidelines for the management of testicular germ cell cancer

No Long-Term Increase in Sperm Aneuploidy Rates after Anticancer Therapy

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