Fischer, Stefanie, Tandstad, Torgrim, Cohn-Cedermark, Gabriella, Thibault, Constance, Vincenzi, Bruno, Klingbiel, Dirk, Albany, Costantine, Necchi, Andrea, Terbuch, Angelika, Lorch, Anja, Aparicio, Jorge, Heidenreich, Axel, Hentrich, Marcus, Wheater, Matthew, Langberg, Carl W., Stahl, Olof, Fankhauser, Christian Daniel, Hamid, Anis A., Koutsoukos, Konstantinos, Shamash, Jonathan, White, Jeff, Bokemeyer, Carsten, Beyer, Jorg and Gillessen, Silke ORCID: 0000-0001-5746-6555 (2020). Outcome of Men With Relapses After Adjuvant Bleomycin, Etoposide, and Cisplatin for Clinical Stage I Nonseminoma. J. Clin. Oncol., 38 (12). S. 1322 - 1333. ALEXANDRIA: AMER SOC CLINICAL ONCOLOGY. ISSN 1527-7755

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Abstract

PURPOSEClinical stage I (CSI) nonseminoma (NS) is a disease limited to the testis without metastases. One treatment strategy after orchiectomy is adjuvant chemotherapy. Little is known about the outcome of patients who experience relapse after such treatment.PATIENTS AND METHODSData from 51 patients with CSI NS who experienced a relapse after adjuvant bleomycin, etoposide, and cisplatin (BEP) from 18 centers/11 countries were collected and retrospectively analyzed. Primary outcomes were overall and progression-free survivals calculated from day 1 of treatment at first relapse. Secondary outcomes were time to, stage at, and treatment of relapse and rate of subsequent relapses.RESULTSMedian time to relapse was 13 months, with the earliest relapse 2 months after start of adjuvant treatment and the latest after 25 years. With a median follow-up of 96 months, the 5-year PFS was 67% (95% CI, 54% to 82%) and the 5-year OS was 81% (95% CI, 70% to 94%). Overall, 19 (37%) of 51 relapses occurred later than 2 years. Late relapses were associated with a significantly higher risk of death from NS (hazard ratio, 1.10 per year; P = .01). Treatment upon relapse was diverse: the majority of patients received a combination of chemotherapy and surgery. Twenty-nine percent of patients experienced a subsequent relapse. At last follow-up, 41 patients (80%) were alive and disease-free, eight (16%) had died of progressive disease, and one patient (2%) each had died from therapy-related or other causes.CONCLUSIONOutcomes of patients with relapse after adjuvant BEP seem better compared with patients who experience relapse after treatment of metastatic disease but worse compared with those who have de-novo metastatic disease. 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 NS relapse (< 2 years), and late viable NS relapse (> 2 years).

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Fischer, StefanieUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Tandstad, TorgrimUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cohn-Cedermark, GabriellaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Thibault, ConstanceUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Vincenzi, BrunoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Klingbiel, DirkUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Albany, CostantineUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Necchi, AndreaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Terbuch, AngelikaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lorch, AnjaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Aparicio, JorgeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Heidenreich, AxelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hentrich, MarcusUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wheater, MatthewUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Langberg, Carl W.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stahl, OlofUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fankhauser, Christian DanielUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hamid, Anis A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Koutsoukos, KonstantinosUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Shamash, JonathanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
White, JeffUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bokemeyer, CarstenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Beyer, JorgUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gillessen, SilkeUNSPECIFIEDorcid.org/0000-0001-5746-6555UNSPECIFIED
URN: urn:nbn:de:hbz:38-336776
DOI: 10.1200/JCO.19.01876
Journal or Publication Title: J. Clin. Oncol.
Volume: 38
Number: 12
Page Range: S. 1322 - 1333
Date: 2020
Publisher: AMER SOC CLINICAL ONCOLOGY
Place of Publication: ALEXANDRIA
ISSN: 1527-7755
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
GERM-CELL TUMORS; HIGH-DOSE CHEMOTHERAPY; TESTICULAR CANCER; HIGH-RISK; MALIGNANCIES; EXPERIENCE; MANAGEMENT; CYCLEMultiple languages
OncologyMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/33677

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