In a study reported in the Journal of Clinical Oncology, Fischer et al found different patterns of relapse and associated outcomes among men with relapse after treatment with adjuvant bleomycin/etoposide/cisplatin for clinical stage I nonseminoma.

The study included data on 51 patients from 18 centers in 11 countries who relapsed after orchiectomy and adjuvant bleomycin/etoposide/cisplatin for clinical stage I nonseminoma. Patients had a median age of 30.5 years at orchiectomy, and adjuvant chemotherapy was started at a median of 40 days after surgery. Overall and progression-free survival were calculated from day 1 of treatment at first relapse.

Key Findings 

Median follow-up was 96 months. Among all patients, 5-year progression-free survival was 67% and 5-year overall survival was 81%.

Median time to relapse was 13 months, with the earliest relapse occurring at 2 months after start of bleomycin/etoposide/cisplatin treatment and the latest after 25 years. Overall, 63% of relapses occurred during the first 2 years after adjuvant treatment; 8% occurred between year 2 and 3, and 29% occurred at ≥ 3 years.

Median time to relapse among patients relapsing with teratoma only was shorter than that among patients experiencing relapse with nonteratoma (9 vs 20 months, P < .001). A total of 10 patients (20%) had relapse more than 5 years after adjuvant treatment, and these relapses were associated with increased risk for subsequent progression or death (hazard ratio [HR] = 1.13 per year, P = .002) and increased risk for death (HR = 1.10 per year, P = .01).

After treatment for relapse, 15 patients (29%) experienced subsequent relapse; median time from first to subsequent relapse was 9 months. Death occurred in nine of these patients and was due to nonseminoma progression in eight.

Overall, relapses could be categorized as: pure teratoma relapses treated with surgery alone; early nonseminoma relapses less than 2 years after adjuvant treatment; and late nonseminoma relapses more than 2 years after adjuvant treatment. The nonseminoma-specific death rates in these three groups were 0%, 13%, and 28%, respectively.

The investigators concluded, “We report the first, to our knowledge, retrospective analysis focusing exclusively on patients with [clinical stage I nonseminoma] who were treated with adjuvant bleomycin/etoposide/cisplatin and who had an unequivocal relapse. The median time to relapse in this analysis was long, at 13 months, and approximately one-third of patients experienced relapse more than 3 years after adjuvant treatment…. We found a substantial rate of late and subsequent relapses. There seem to be three patterns of relapse with different outcomes: pure teratoma, early viable [nonseminoma] relapse (< 2 years), and late viable [nonseminoma] relapse (> 2 years).”

Silke Gillessen, MD, is the corresponding author for the Journal of Clinical Oncology article. 

Disclosure: The study was supported by a Swiss Group for Clinical Cancer Research/Astellas GU Oncology Award and by the Swiss Cancer League. For full disclosures of the study authors, visit ascopubs.org.