Abstract 515P
Background
Testicular GCT is an extremely chemosensitive malignancy and has excellent survival rates. We looked at the prognostic significance of raised STMs after the first cycle of chemotherapy in men with intermediate and poor risk NSGCT.
Methods
We performed a detailed chart-review of patients with intermediate and poor risk NSGCT treated at our tertiary care cancer centre in New Delhi, India from 2015-2022. International Germ Cell Cancer Collaborative Group risk categories were used. We developed multivariable Cox regression models, adjusted for measured confounders, to analyse the prognostic impact of normal STM at the end of first cycle of chemotherapy on overall survival (OS) and relapse free survival (RFS).
Results
A total of 329 patients with testicular NSGCT were identified; 116 were intermediate (n=53, 45.6%) and poor risk (n=63, 54.3%). The median age at diagnosis was 28 (range, 16-59) years. Men with poor risk NSGCT were more likely to have ECOG PS > 1 at diagnosis (66.7% vs 39.6%). BEP (86.1%) and VIP (13.9%) regimens were administered, and salvage surgery for residual tumor was performed in 22.4%. Overall, normal STM after the first cycle of chemotherapy were seen in 23.3%, and intermediate risk patients were more likely to have normal STM (32.1% vs 15.9%). The 5-year RFS rate was 63% (poor risk 51% and intermediate risk 76%), and OS rate was 69% (57% and 81%, respectively). Those with normal STM after the first cycle of chemotherapy had a better RFS (hazard ratio [HR], 0.63; 95% confidence interval 0.45-0.71; P<0.001) and OS (HR,0.76; 95% CI 0.59-0.88; P=0.01). After adjusting for age, ECOG PS, and risk group in multivariable Cox regression model, patients who had normal STM after the first cycle of chemotherapy continued to have better survival (adjusted HR for RFS, 0.68; 95% CI, 0.56-0.78; P=0.01, and adjusted HR for OS, 0.86; 95% CI,0.71-0.92; P=0.04).
Conclusions
Patients with NSGCT whose STMs fail to normalize after the first BEP/VIP chemotherapy have worse survival outcomes (RFS and OS) compared to those with normal STM at this time-point. Future clinical trials should focus on elucidating the role of escalation of chemotherapy in such patients.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.