813PD - Brain metastases in male germ cell tumors (GCT): A large retrospective analysis on behalf of the SWENOTECA and the G3 CONSORTIUM

Date 29 September 2014
Event ESMO 2014
Session Genitourinary tumours, non prostate
Topics Germ Cell Tumours
Presenter Joerg Beyer
Citation Annals of Oncology (2014) 25 (suppl_4): iv280-iv304. 10.1093/annonc/mdu337
Authors J. Beyer1, A. Lorch2, T.B. Powles3, A. Kramar4, L. van Alstine2, P. Giannatempo5, T. Sava6, C. Albany7, L. Einhorn7, A. Flechon8, J. Aparicio9, P. Chung10, R.A. Huddart11, C. Bokemeyer12, A. Tryakin13, E. Winquist14, C. Sweeney15, M. Hentrich16, K. Margolin17, D.R. Feldman18
  • 1Department Of Oncology, Universitätsspital Zürich, 8091 - Zürich/CH
  • 2Urology, University of Düsseldorf, Duesseldorf/DE
  • 3Medical Oncology, St. Bart's Hospital & Medical School, London/GB
  • 4Biostatistics, Centre Oscar Lambret, Lille/FR
  • 5Dept. Genitourinary, Fondazione IRCCS - Istituto Nazionale dei Tumori, 20133 - milan/IT
  • 6Oncologia Do, Azienda Ospedaliera Universitaria Integrata Verona, IT-37126 - Verona/IT
  • 7Medical Oncology, Indiana University Simon Cancer Center, Indianapolis/US
  • 8Oncology Departement, Centre Léon Bérard, 69008 - LYON/FR
  • 9Medical Oncology Department, La Fe University Hospital, 46009 - Valencia/ES
  • 10Radiation Oncology, Princess Margaret Hospital, Toronto/CA
  • 11-, Royal Marsden HospitalInstitute of Cancer Research, GB-SM2 5NG - Sutton/GB
  • 12Dept. Hemato/oncology, UKE Universitätsklinikum Hamburg-Eppendorf KMTZ, 20246 - Hamburg/DE
  • 13Clinical Pharmacology And Chemotherapy, N. N. Blokhin Russian Cancer Research Center, RU-115478 - Moscow/RU
  • 14Medical Oncology, University of Western OntarioLondon Regional Cancer Center, CA-N6A 4L6 - London/CA
  • 15Medical Oncology, Dana Faber Institute, Boston/US
  • 16Klinik Für Onkologie, Städtisches Klinikum München GmbH, München/DE
  • 17Medical Oncology, University of Washington Seattle Cancer Care Alliance, Seattle/US
  • 18Medical Oncology, MSKCC, New York/US

Abstract

Aim

Characteristics, treatment and outcome of patients (pts) with brain metastases (BMet) from GCT are largely unknown due to a lack of data. We addressed these issues in a large international retrospective cohort.

Methods

Data on pts diagnosed with BMet between 1990 and 2013 was retrospectively collected across 46 institutions worldwide. Data collection and analyses followed a predefined protocol and had obtained appropriate ethical approval. Univariate analysis was used to identify prognostic factors. The Kaplan Meier method was used to assess outcome.

Results

Data on 523 patients were collected: 228 (44%) in pts with BMet at initial diagnosis (group A) and 295 (56%) in pts with BMet at relapse (group B), 150 (31%) pts were asymptomatic at presentation. Median age was 29 years (range 16-67 years). Median follow-up after diagnosis of BMet was 7 years. Pts from group A had a significantly better PFS (median 6.9 versus 3.6 months, HR 0.60: 95%CI; 0.49 – 0.73; P < 0.0001) and OS (median 29.5 versus 8.0 months, HR 0.50: 95%CI: 0.40 – 0.62); P < 0.0001) compared to pts from group B. Pts with multiple BMet from both groups had a worse OS than those with single BMet (HR 1.77: 95%CI: 1.17 – 2.68; P < .005 in group A and HR 1.89: 95%CI: 1.42 – 2.51; P < 0.0001 in group B, respectively). Presence of liver and/or bone metastases also negatively impacted on survival. Surgery and to a lesser degree radiotherapy in addition to chemotherapy were associated with improved OS in both groups. The combination of chemotherapy, radiotherapy and surgery was associated with improved survival only in group B. High-dose chemotherapy (HDCT) was also associated with improved survival only in group B.

Conclusions

Conclusions: Pts with GCT and BMet can be cured. Pts with BMet at initial diagnosis and those with solitary BMet have superior outcomes compared to pts with BMet at relapse or with multiple BMet lesions. Surgery and/or radiotherapy in addition to chemotherapy as well as HDCT in pts with BMet at relapse may improve survival.

Disclosure

All authors have declared no conflicts of interest.