Successful Retreatment With Cisplatin-Based Therapy Reported in Men Relapsing After Adjuvant Carboplatin for Stage I Seminoma


Key Points

  • Cisplatin-based chemotherapy was associated with good outcomes after disease progression in men with stage I seminoma who had relapsed after adjuvant carboplatin.
  • A total of 15% of relapses occurred > 3 years after initial treatment.

In an analysis reported in the Journal of Clinical Oncology, Fischer et al found that men with clinical stage I seminoma who relapsed after adjuvant carboplatin could be successfully re-treated with cisplatin-based chemotherapy.

Study Details

The analysis included data from 185 patients who relapsed after adjuvant carboplatin between January 1987 and August 2013 at 31 sites in 20 countries. Of them, 156 patients (84%) received chemotherapy alone and 14 patients (8%) were treated with a combination of chemotherapy and radiotherapy or surgery. Of the 156 patients receiving chemotherapy alone, treatment consisted of 3 cycles of bleomycin, etoposide, and cisplatin (BEP) in 56 patients (36%) and 4 cycles of etoposide/cisplatin in 52 patients (33%); 4 cycles of BEP were used in 16 patients (10%), and 32 patients (21%) were treated with other combinations/schedules.

Disease-Free and Overall Survival

Among all patients, with a median follow-up of 53 months, 5-year disease-free survival was 82% and 5-year overall survival was 98%. In the subgroup of 111 patients (60%) who received standard chemotherapy alone according to the stage and prognostic International Germ Cell Cancer Collaborative Group—defined as 3 cycles of BEP or 4 cycles of etoposide/cisplatin (n = 108) for a good prognosis and 4 cycles of BEP (n = 3) for an intermediate prognosis—5-year disease-free survival was 82% and 5-year overall survival was 97%.

Second relapse occurred in 28 patients; at last follow-up, 174 patients (94%) were alive without disease, and 4 were alive with disease. Seven patients died, three due to progressive disease.

Overall, the median time from orchiectomy to relapse was 19 months, with 15% of relapses occurring at > 3 years after treatment. Most relapses were detected by computed tomography during routine follow-up, with 98% being in the International Germ Cell Cancer Collaborative Group good-prognosis group.

The investigators concluded: “Within the limitations of a retrospective analysis, the results suggest that the majority of patients who experience a relapse after adjuvant carboplatin for clinical stage I seminoma can be successfully treated with a cisplatin-based chemotherapy regimen adequate for stage. Because 15% of the relapses occurred > 3 years after adjuvant treatment, a minimum of 5 years of follow-up is recommended.”

The study was supported by the Swiss Cancer Foundation.

Silke Gillessen, MD, of Cantonal Hospital St. Gallen, is the corresponding author of the Journal of Clinical Oncology article.

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