Dose-reduced first cycle of chemotherapy for prevention of life-threatening acute complications in nonseminomatous germ cell tumor patients with ultra high tumor markers and/or poor performance status

Tryakin, А. А.; Fedyanin, Mikhail; Bulanov, A.; Кашиа, Шалва Робертович; Курмуков, И. А.; Matveev, Vsevolod; Fainstein, I.; Гордеева, О. О.; Zakharova, T.; Tjulandin, Sergei

doi:10.1007/s00432-018-2695-4

Cited by 10 publications

(11 citation statements)

References 8 publications

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“…The 5-years OS rates was 52%, equal in both groups (HR 0.99, 95% CI 0.44–2.26, p = 0.99). However, OS in the group of patients with ultra-high tumor marker levels ( n = 63), compared with the group of other patients with poor-risk ( n = 202), did not differ significantly (HR 0.89, 95% CI 0.58–1.36, P = 0.59 (25, 26).…”

Section: Treatment Outcomementioning

confidence: 92%

“…Based on this knowledge, a reasonably effective approach can be a reduced respectively, shortened course of induction chemotherapy before the administration of consecutive full-dose chemotherapy as the eventual prevention of ARDS development in these patients. All three retrospective studies with modified induction chemotherapy showed non-inferior treatment results compared to full-dose induction chemotherapy (24–26). These studies suggest that reduced induction chemotherapy can be helpful to decrease the incidence of ARDS in this group of patients.…”

Section: Treatment Outcomementioning

confidence: 99%

“…The effective approach appeared to be either reduced or shortened course of the induction chemotherapy before the administration of the full-dose chemotherapeutical regimen. Three retrospective studies tested the alternative regimens during induction chemotherapy to decrease the mortality rate due to acute complications connected with administered chemotherapy (24–26)…”

Section: Treatment Outcomementioning

confidence: 99%

“…In the study published by Tryakin et al in 2018, authors retrospectively assessed 63 (24%) out of 265 patients with poor risk metastatic GCTs, all with ultra-high tumor marker levels and/or an ECOG performance status of 3–4 (26). Before 2005, these patients were treated with full dose BEP; after 2005, the patients were treated with abbreviated EP as the induction chemotherapy, followed by subsequent full-dose chemotherapy.…”

Section: Treatment Outcomementioning

confidence: 99%

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Severe Complications in Testicular Germ Cell Tumors: The Choriocarcinoma Syndrome

et al. 2019

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Testicular germ cell tumors (TGCTs) represent the most common solid tumor in young men and is a model of curable cancer. The effectiveness of cisplatin-based chemotherapy secures more than 95% of patients' 5-years survival rate. However, some high-risk patients with a very advanced disease develop choriocarcinoma syndrome (CS) connected with acute respiratory failure with poor prognosis and high mortality rate shortly after beginning systemic chemotherapy. CS was first described as a syndrome with hemorrhage from metastatic sites in patients with TGCTs with significantly high choriogonadotropin level. Acute hemorrhage to lung metastases is typical, but hemorrhage can occur from any metastatic site. Patognomic of choriocarcinoma cells is an invasion of small blood vessels within CS. The incidence of CS in patients with TGCTs are not well-defined and can vary across the world. To date, there are a few case reports and small retrospective series reporting a connection between systemic chemotherapy and the development of CS in metastatic TGCTs. CS is known to be triggered by massive tumor cell lysis as a result of chemotherapy and cytokine release, aggravated with alveolar hemorrhage. This can lead to a consecutive superinfection, furthered with neutropenia after chemotherapy, acute respiratory distress syndrome, rising to systemic inflammatory response, resulting in multiorgan failure and death. A reasonably effective approach in patients with extensive disease could be a shortened course of chemotherapy as well as a reduction of dosage in induction chemotherapy before full-dose chemotherapeutical regimen; however, current data regarding optimal treatment approach are limited. Patients' referral to tertiary centers and the administration of induction chemotherapy in an intensive care unit setting could further improve the treatment outcome.

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Section: Treatment Outcomementioning

confidence: 92%

Section: Treatment Outcomementioning

confidence: 99%

Section: Treatment Outcomementioning

confidence: 99%

Section: Treatment Outcomementioning

confidence: 99%

See 2 more Smart Citations

Severe Complications in Testicular Germ Cell Tumors: The Choriocarcinoma Syndrome

et al. 2019

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“…Testicular cancer is largely found in young and middle-age men, but around 7% of cases occur in children (11)(12)(13)(14)(15)(16)(17)(18)(19).…”

Section: Discussionmentioning

confidence: 99%

Testicular germ cells tumors in adolescents and young adults: Management and outcomes from a single-center experience

Spinelli

Cito

Morelli

et al. 2021

Arch Ital Urol Androl

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Objective: To investigate and compare the effectiveness of active surveillance versus post-surgical active treatment, in patients with testicular germ cells tumor (TGCT). Materials and methods: We retrospectively analyzed 52 patients who underwent surgery for TGCT from January 2009 to December 2014. All the patients were divided into two age groups: the Group A included children-adolescents from 18 months to 21 years old, while the Group B comprised young adults from 22 to 39 years old. Clinical, histopathological, therapeutic and follow-up data were collected. Results: Overall, 22 patients (42,3%) were enrolled in the Group A and 30 patients (57.7%) were categorized in the Group B. Inguinal orchiectomy was performed in all patients. Retroperitoneal lymphadenectomy was performed in 4 patients (7.7%). Post-surgical management differed based on clinical stage, resulting in active surveillance or adjuvant therapy. After an average 7 years follow-up period (range: 3.5-9.0 years), the overall survival rate is 100%. The relapse risk is significantly higher for the patients in the Group B, displaying a recurrence free-survival rate of 72% versus 95% (Group A); 11 relapses (21.1%) were recorded 2 years after surgery. Of these, 3 recurrences (12.0%) occurred in patients undergoing an active surveillance approach, while 8 (29.6%) in patients subjected to an active treatment. Conclusions: The excellent prognosis in both age groups confirms the high curability of this neoplasia. The active surveillance could represent an optimal option for low recurrence risk tumors. However, post-surgical treatments should be taken into consideration for TGCT with high risk factors, including tumor size, lymphovascular and rete testis invasion.

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Improving the performance status in advanced non-small cell lung cancer patients with chemotherapy (ImPACt trial): a phase 2 study

Pathak

Garg

Khurana

et al. 2023

J Cancer Res Clin Oncol

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This phase II trial is designed to test whether the performance status(PS) of metastatic non-small cell lung cancer(mNSCLC) patients(pts) can improve with chemotherapy if their poor PS(Eastern Cooperative Oncology Group(ECOG)PS of ≥ 2) is due to disease burden rather than comorbidities. MethodsAge18-65 years, Charlson's comorbidity index < 9, serum albumin ≥ 3.5g/dl, adequate bone marrow and organ function, & ECOG PS ≥ 2 as judged by the worst score of three independent physicians were administered 3 doses of weekly paclitaxel at 60mg/m 2 /dose. The primary endpoint was an improvement in ECOG PS by 1 point at 4 weeks; others: toxicity (CTCAE v 5.0), quality of life(QoL)assessment at baseline and 4 weeks by EORTC QLQ-C30 and EORTC QLQ-LC13. Optimal Simon's 2-stage design was used. ResultsForty-six patients were included with a median age of 56years(interquartile range, IQR 54-59), 12(26%) had comorbid conditions, and 87% with ECOG PS 3/4. PS improved in 11 pts at 4 weeks and in 7 beyond this time point. Grade 3/4 toxicities are seen in 20%(most common: anemia and diarrhea). At a median follow-up of 4.8m (95% CI: 3.27-14.9), the median progression-free survival & overall survival were 3.3 months (95% CI: 2.36-5.6) & 6.8months (95% CI 2.47-8.8),respectively. QoL improved for global QoL, role functioning, pain, dyspnea, insomnia, pain in chest, pain in other parts, & worsened for alopecia and sore mouth. ConclusionsAbbreviated chemotherapy is a useful, well-tolerated strategy in carefully selected poor PS mNSCLC patients that can improve PS and QoL. Clinical trial information: CTRI/2020/01/022617. Patient eligibilityAll patients of histologically proven stage IIIC/IV NSCLC (AJCC 8th ed)(Rami-Porta et al. 2014), aged 18-65 years, with ECOG PS of 2 or more, were eligible for this study. Inclusion criteria also encompassed adequate bone marrow, liver, and kidney function: de ned as hemoglobin of ≥ 8g/dl, platelet count of ≥ 1,00,000/mm 3 , ANC of ≥ 1500cells/ mm 3 , bilirubin less than 2 times ULN, transaminases less than 3 times ULN, and an estimated GFR of ≥ 30ml/min/BSA, respectively. Charlson's comorbidity index(CCI) score (Charlson et al. 1987;Zhao et al. 2017) was calculated at baseline. Participants should have had a CCI score of less than 9 with any comorbid conditions under control and a serum albumin of ≥ 3.5g/dl.Patients who were pregnant or lactating, had secondary malignancy, had HIV or hepatitis B or C positive status, known driver mutation-positive status for EGFR/ALK/ROS1, and symptomatic untreated brain metastasis was excluded from the study. Unknown/pending driver mutation status patients were allowed to be enrolled, and if they were found to have these alterations during the course, they were excluded from the study. Treated brain metastasis or those with asymptomatic brain metastasis were allowed. Informed consent was obtained from all participants. Treatment/InterventionEnrolled patients received paclitaxel at 60mg/m 2 of body surface area (BSA) intravenously (IV) over 1 hour every seven days (±1 da...

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Dose-reduced first cycle of chemotherapy for prevention of life-threatening acute complications in nonseminomatous germ cell tumor patients with ultra high tumor markers and/or poor performance status

Abstract: Dose reduction of the first EP cycle by 40-60% in the subgroup of poor risk patients with ultra high tumor marker levels and/or ECOG performance status 3-4 is associated with significantly lowered acute complication rates but not with overall survival.

Cited by 10 publications

References 8 publications

Severe Complications in Testicular Germ Cell Tumors: The Choriocarcinoma Syndrome

Severe Complications in Testicular Germ Cell Tumors: The Choriocarcinoma Syndrome

Testicular germ cells tumors in adolescents and young adults: Management and outcomes from a single-center experience

Improving the performance status in advanced non-small cell lung cancer patients with chemotherapy (ImPACt trial): a phase 2 study

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