860P - Impact of response to induction chemotherapy in patients with germ cell tumors (GCT) receiving salvage high-dose chemotherapy (HDCT): A study of th...

Date 27 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anti-Cancer Agents & Biologic Therapy
Germ Cell Tumours
Presenter Andrea Necchi
Citation Annals of Oncology (2014) 25 (suppl_4): iv280-iv304. 10.1093/annonc/mdu337
Authors A. Necchi1, R. Miceli2, L.A. Berger3, K. Schumacher4, J.H. Bourhis5, D. Laszlo6, E. Nicolas-Virelizier7, F. Arpaci8, S. Secondino9, P. Dreger10, W. Kruger11, M. Ringhoffer12, A. Unal13, A. Nagler14, A. Campos15, A. Wahlin16, I. Donnini17, M. Badoglio18, P. Pedrazzoli19, F. Lanza20
  • 1Medical Oncology/urology Unit, Fondazione IRCCS - Istituto Nazionale dei Tumori, 20133 - Milano/IT
  • 2Clinical Epidemiology And Trials Organization Unit, Fondazione IRCCS - Istituto Nazionale dei Tumori, 20133 - Milano/IT
  • 3Oncology And Hematology, Klinik für Onkologie, Hämatologie, KMT- Universitätsklinikum, Hamburg/DE
  • 4Hematology And Oncology, UKGM- Marburg Klinik for Hematology and Oncology, Marburg/DE
  • 5Bmt Service, Division Of Hematology- Department Of Medical Oncology, Gustave Roussy, institut de cancérologie, Villejuif/FR
  • 6Hematology, European institute of Oncology, Milan/IT
  • 7Hematology And Oncology, Centre Léon Bérard, Lyon/FR
  • 8Bmt Unit Department Of Hematology, GATA BMT Center- Gülhane Military Medical Academy, Ankara/TR
  • 9Oncology And Hematology, Ospedale San Matteo, Pavia/IT
  • 10Medizinische Klinik, Universitätsklinikum Heidelberg, Heidelberg/DE
  • 11Hematology And Oncology, Universitätsmedizin - Klinik Innere Medizin C, Greifswal/DE
  • 12Iii. Med. Klinik -haematologie, Onkologie, Klinikum Karlsruhe gGmbH, Karlsruhe/DE
  • 13Dept. Of Hematology - Oncology, Erciyes Medical School Kapadokya BMT Center, Kayseri/TR
  • 14Hematology And Oncology, Chaim Sheba Medical Center, Tel-Hashomer/IL
  • 15Bmt Unit, Inst. Português de Oncologia do Porto, Porto/PT
  • 16Hematology And Oncology, Umea University Hospital, Umeå/SE
  • 17Bmt Unit Department Of Hematology, University Hospital of Careggi, Firenze/IT
  • 18Ebmt Offices, EUropean Society for Blood and Marrow Transplantation (EBMT), Paris/FR
  • 19Onco-ematologia, Ospedale San Matteo, 27100 - Pavia/IT
  • 20Section Of Hematology & Bmt Unit, HOSPITAL OF CREMONA, Cremona/IT

Abstract

Aim

HDCT has a recognized indication in the salvage setting of advanced GCT and is steadily utilized worldwide. While the prognostic impact of response to prior lines of CT is ascertained, that of response to induction/mobilization CT preceding single or multiple HDCT cycles is unknown. We present the results of a retrospective study of the EBMT-STWP.

Methods

Data have been collected from 16 European centers. Eligibility included adult male patients (pts) with GCT, and treatment with second or further-line HDCT between the years 2002 and 2012. Distribution of frequencies were compared between the years <2008 and ≥2008. A multivariable Cox regression model was used to evaluate the association of prespecified factors (site of tumor primary, IGCCCG category, response to induction CT, response to prior lines [chemosensitive vs chemorefractory], line of HDCT, year of HDCT, and regimen) with progression-free (PFS) and overall survival (OS).

Results

Since 10/2013, 313 pts have been registered. All pts mobilized with GCSF (26 [8%] with GCSF only). 21 mobilization regimens were used, including 11 platinum-based CT. 13 different HDCT regimens were administered as single (n = 74), double (n = 102), or multiple (n = 137) courses. A stepwise harmonization of HDCT regimens was observed, and carboplatin-etoposide (CE) was more frequent in recent years (40.8 vs 73.8%). 45 pts (14%) had a progression to induction, 231 (74%) a response (11 missing and 26 GCSF only). In the multivariable model for PFS, mediastinal primary (HR: 2.32, 95%CI, 1.08-4.96, p = 0.042), IGCCCG poor prognostic category (HR: 1.76, 95%CI, 1.08-2.84, p = 0.048), and progression to induction (HR: 1.93, 95%CI: 1.27-2.93, p = 0.008) were significantly prognostic. The latter was the only significant prognostic factor for OS (HR: 2.46, 95%CI, 1.54-3.91, p < 0.001).

Conclusions

Response to induction CT prior to HDCT was independently and significantly associated with PFS and OS, while response or progression to prior CT lines was not. This information could have important implications to refine patient eligibility to transplantation in this disease. These data need external validation.

Disclosure

All authors have declared no conflicts of interest.