In a long-term analysis reported in the Journal of Clinical Oncology, Gleeson et al found that initial salvage treatment for germ cell tumors with paclitaxel, ifosfamide, and cisplatin (TIP) was associated with positive long-term outcomes in both favorable- and unfavorable-risk disease.
Study Details
The analysis included 46 patients from an original phase II study and 58 patients from the Memorial Sloan Kettering Cancer Center (MSK) database who received second-line TIP for advanced germ cell tumors between May 1994 and October 2019. Of the 104 patients, 87 had favorable-risk and 17 had unfavorable-risk disease per MSK criteria. A total of 10 patients were treated for a second gonadal primary germ cell tumor. Favorable response was defined as complete response or partial response with normal tissue markers.
Key Findings
Median follow-up was 8.9 years. Among all patients, the 5-year progression-free survival rate was 66% (95% confidence interval [CI] = 55%–74%), and the 5-year overall survival rate was 69% (95% CI = 59%–77%).
Among 87 patients with MSK favorable-risk disease, 69 (79%) had a favorable response; the 5-year progression-free survival rate was 67% (95% CI = 56%–76%), and the 5-year overall survival rate was 72% (95% CI = 61%–80%). Among 17 patients with MSK unfavorable-risk disease, 13 (76%) achieved a favorable response; the 5-year progression-free survival rate was 59% (95% CI = 33%–78%), and the 5-year overall survival rate was 56% (95% CI = 28%–76%).
The investigators concluded: “TIP is an effective second-line regimen for patients with germ cell tumors. Similar outcomes were observed in patients with favorable- and unfavorable-risk disease. The randomized TIGER trial (ClinicalTrials.gov identifier NCT02375204) comparing TIP with high-dose chemotherapy will determine the optimal second-line treatment approach.”
Darren R. Feldman, MD, of the Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, is the corresponding author of the Journal of Clinical Oncology article.
Disclosure: The study was supported by the National Cancer Institute, ASCO/Conquer Cancer Foundation Young Investigator Award, and others. For full disclosures of the study authors, visit ascopubs.org.
