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

Abstract

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.

Administration of standard-dose BEP regimen (bleomycin+etoposide+cisplatin) is essential for treatment of ovarian yolk sac tumour

“…The recommended dose and administration schedule in the National Comprehensive Cancer Network (NCCN) guideline is bleomycin 30 units per week; etoposide 100 mg/m 2 /day daily for days 1-5; and cisplatin 20 mg/m 2 /day daily for days 1-5 for 3-4 cycles [12]. However, the BEP regimen is sometimes administered with a reduced dose of bleomycin and/or etoposide because of the potential for serious adverse reactions such as severe bone marrow suppression, pulmonary fibrosis or secondary leukaemia [13][14][15][16][17]. Therefore, the present study investigated whether the use of BEP, especially standard-dose BEP, is associated with OS in patients with YST, in addition to other prognostic factors.…”

Long-term Relative Survival after Diagnosis of Testicular Germ Cell Tumor

“…4). In addition, TGCT-specific mortality is reported to increase with increasing age at diagnosis (21,22). Seminoma patients might be at a particular risk of treatment-associated late toxicity due to increased median age at diagnosis, explaining the more rapid decline in RS (Fig.…”

Pulmonary and cardiovascular toxicity in long-term testicular cancer survivors

“…It should be noted that age greater than 40 years gave a 2.3-fold increased risk of BPT [12]. A recent Danish study including measurements of lung function before each cycle and during follow-up reported that most men aged Z40 years tolerated bleomycin if the lung function was monitored carefully, with discontinuation of bleomycin if DLCO decreased 425% during treatment [32]. No patients aged Z40 years experienced a fatal BPT.…”