In a single-center retrospective analysis reported by McHugh et al in the Journal of Clinical Oncology, two cycles of adjuvant etoposide plus cisplatin proved highly effective in patients with pathologic stage II nonseminomatous germ cell tumors. The combination also had acceptable toxicity and incurred less cost than two cycles of bleomycin/etoposide/cisplatin.
As stated by the investigators, the accepted adjuvant regimens in this setting include both two cycles of bleomycin, etoposide, and cisplatin and two cycles of etoposide and cisplatin. Since both provide “excellent” disease-specific survival, there are questions regarding the need for bleomycin and the potential for avoiding bleomycin-associated toxicity.
Study Details
The study included all patients with pathologic stage II nonseminomatous germ cell tumors treated at Memorial Sloan Kettering Cancer Center from March 1989 to April 2016 whose treatment plan was to receive two cycles of adjuvant etoposide and cisplatin after primary retroperitoneal lymph node dissection. Cycles consisted of cisplatin at 20 mg/m² and etoposide at 100 mg/m² on days 1 through 5 in 21-day intervals.
“[Two] adjuvant [cycles of etoposide/cisplatin] for [pathologic stage] II [nonseminomatous germ cell tumor] is highly effective, has acceptable toxicity, and incurs less drug cost than two cycles of bleomycin, etoposide, and cisplatin. Inclusion of bleomycin in this setting is not necessary.”— McHugh et al
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Key Findings
Of the total of 156 eligible patients, 30 (19%) had pathologic N1, 122 (78%) had pathologic N2, and 4 (3%) had pathologic N3 disease. The median number of involved lymph nodes was three (range = 1–37 nodes), and the median size of the largest involved node was 2.0 cm (range = 0.4–7.0 cm); 69 patients (45%) had extranodal extension. A total of 143 patients (92%) had embryonal carcinoma.
Overall, 150 patients (96%) received two cycles of etoposide/cisplatin, 5 received one cycle of etoposide/cisplatin, and 1 received four cycles of etoposide/cisplatin. After a median follow-up of 9 years, relapse occurred in two patients (1.3%), consisting of one patient each with pathologic N2 and pathologic N3 disease, respectively. After salvage chemotherapy, the patients have remained disease-free for > 5 and > 22 years. Three deaths occurred, with none considered related to nonseminomatous germ cell tumor. In the entire cohort, the 10-year disease-specific, relapse-free, and overall survival rates were 100%, 98%, and 99%.
The investigators concluded, “[Two cycles of] adjuvant [etoposide/cisplatin] for [pathologic stage] II [nonseminomatous germ cell tumor] is highly effective, has acceptable toxicity, and incurs less drug cost than two cycles of bleomycin, etoposide, and cisplatin. Inclusion of bleomycin in this setting is not necessary.”
Darren R. Feldman, MD, of the Genitourinary Oncology Service and Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the National Institutes of Health and the Tifford Fund. For full disclosures of the study authors, visit ascopubs.org.
