701P - Multicenter analysis of first-line (1L) regimens (BEP vs VIP) in patients (pts) with non-seminomatous germ cell tumors (NSGCTs) who subsequently underwent high-dose chemotherapy (HDCT)

Background

Four cycles of bleomycin, etoposide, cisplatin (BEPx4) or etoposide, ifosfamide, cisplatin (VIPx4), are the standard 1L treatments for Stage IIIB/IIIC NSGCTs. Limited data exists comparing outcomes between BEPx4 and VIPx4 in pts who subsequently received HDCT. We aimed to address this gap by pooling data from four high-volume referral centers.

Methods

We collated data from four high-volume referral centers. We included adult pts diagnosed with NSGCTs who underwent either BEPx4 or VIPx4 as 1L chemotherapy followed by HDCT for recurrent NSGCT between January 1, 2010, and January 1, 2024. Differences among pts groups were assessed using the Fisher's exact test for qualitative variables and the Wilcoxon rank-sum test for quantitative variables. Relapse-free survival (RFS) and overall survival (OS) were estimated using the Kaplan-Meier method and compared using the log-rank test.

Results

58 pts across four institutions met the specified criteria. Of these, 37 (63.8%) pts received BEPx4, and 21 (36.2%) pts received VIPx4 as the 1L chemotherapy. Median age at diagnosis was 27 years (range, 18-51), and 38 (65.5%) pts identified themselves as white. 7 (12.1%) pts had Stage IIIB, 45 (77.6%) had Stage IIIC, and 6 (10.3%) were unstageable. 33 (56.9%) pts underwent HDCT following recurrence after 1L chemotherapy, and 18 (31.0%) received HDCT in the 3rd-line. The median follow-up time after the 1L chemotherapy was 44.3 months. Median RFS following 1L chemotherapy was 23.0 and 24.9 months among pts who received BEPx4 and VIPx4, respectively (HR= 0.84, 95% CI [0.40, 1.75], P=0.637). Median OS following 1L BEPx4 and VIPx4 were 114.6 and 57.7 months, respectively (HR=0.52, 95% CI [0.20, 1.32], P=0.170). Post-transplant relapse rate among pts who received HDCT in the 2nd and 3rd line was 58% and 56% (P=0.99).

Conclusions

In this multicenter comparison of 1L chemotherapy regimens in pts with NSGCT necessitating HDCT due to recurrence, no significant disparities in RFS and OS emerged between BEPx4 and VIPx4. These results underscore the importance of considering factors beyond efficacy, such as regimen safety and toxicity, in selecting 1L chemotherapy.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Alexander Chehrazi-Raffle.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.