790P - Palliative chemotherapy in patients with advanced nonseminomatous germ cell tumors (aNSGCT)

Background

Most of the patients (pts) with aNSGCT can be cured with 1-st line chemotherapy (CT) and about a quarter of relapsed patients can be salvaged after 1-st relapse. There is limited evidence supporting palliative CT in aNSGCT. We performed a retrospective analysis of our pts in order to assess the efficacy of palliative CT.

Methods

Pts with aNSGCT treated with third-line CT were included into analysis. Key inclusion criteria were: cisplatin/etoposide-based first-line CT, platinum-based second-line CT.

Results

From 2000 to 2017, 66 pts were treated with 3^rd line CT. Initially 12 (18%), 16 (24%) and 37 (56%) pts had good, intermediate and poor IGCCCG prognosis, respectively. Mediastinal primary tumor was diagnosed in 9 (14%) pts. Ifosfamide-based CT as 2^nd line treatment was used in 58 (88%) pts. Platinum sensitive, resistant and refractory relapses following 2-nd line CT occurred in 20 (30%), 28 (42%) and 18 (27%) pts, respectively. Third line CT consisted of TGO/TGP regimens (12 [18.2%] pts), gemcitabine/platinum (29 [43.4%] pts), HDCT (TI-CE regimen, 2 [3.0%] pts), ifosfamide-based CT (4 [6.0%] pts), CisCA/VAB-6 regimes (5 [7.6%] pts), non-platinum CT (10 [15.2%] pts). Ten pts underwent resection of residual tumors after 3-d line CT. Histology showed viable malignant tumor in 8 pts. Overall responses included CR/PR marker-negative in 15 (23%), PR marker-positive/stabilization in 12 (18%), progression of the disease in 3 (5%) and were not evaluable in 6 (9%) pts. Median PFS and OS after 3^rd line CT initiation was 2.1 and 6.5 months, respectively. Subsequent relapses developed in 64 (97%) pts. Only 6 (9%) pts are currently alive with no evidence of disease (all with follow-up of 78+ months). All of them were cured by surgery (n=4) or radiation (n=2). Four (31%) of 13 pts with ECOG PS 2-4 had symptoms relief on 3^rd line CT.

Conclusions

Third line chemotherapy has modest activity in pts with aNSGCT. Long term survival can be achieved in small subgroup of pts who are managed using systemic and local treatment modalities.

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.