Three-four cycles of BEP are commonly recognized as a standard 1-st line ChT in aNSGCT. However, there were no trials studying optimal cycles numbers in this setting, especially in case of unfavorable TTN of tumor markers. We performed retrospective single center analysis to evaluate if pts with unfavorable TTN of tumor markers may benefit with prolongation of induction ChT.
Inclusion criteria were as follows: (1) ChT-naïve aNSGCT pts treated with etoposide- and cisplatin-based chemotherapy; (2) AFP and hCG levels available at days 0 and 18-22 of cycle 1 to calculate TTN (Fizazi K., JCO 2004). Pts who received less than “standard” number of cycles (3xBEP or 4xEP for IGCCCG good risk, 4xBEP for intermediate and poor risk) for any reason were excluded from the analysis. Cox` regression multivariate analysis was also performed. TTN was calculated by K.Fizazi’s methodic (JCO 2004).
From 1987 to 2011 952 pts with aNSGCT received 1-st line ChT. 584 pts matched the inclusion criteria. Unfavorable TTN had 24 (11%), 61 (41%) and 122 (84%) of pts with good, intermediate and poor IGCCCG risk, respectively. More than standard number of cycles received 199 pts. Prolongation of ChT did not result in significant improvement of OS in any IGCCCG prognostic groups irrespectively of TTN (Table).Table:
|IGCCCG risk group||TTN/# of cycles||N pts||5-y OS, %||p (HR, 95%CI)|
|favorable/>standard||42||98%||(HR 0,63, 0,23-1,89)|
|unfavorable/> standard||9||78%||(HR 1,48, 0.24-10.48)|
|favorable/>standard||20||80%||(HR 2,1, 0,73-9,38)|
|unfavorable/> standard||29||86%||(HR 0,78, 0.25-2.41)|
|favorable/>standard||10||100%||(HR 0,14, 0.01-2.27)|
|unfavorable/> standard||89||72%||(HR 0,79, 0.33-1.79)|
Prolongation of 1-st line ChT beyond standard number of cycles does not improve outcome of pts with unfavorable TTN of tumor markers.
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All authors have declared no conflicts of interest.