Maintaining success, reducing treatment burden, focusing on survivorship: highlights from the third European consensus conference on diagnosis and treatment of germ-cell cancer

Beyer, Jörg; Albers, Peter; Altena, Renske; Aparicio, Jorge; Bokemeyer, Carsten; Busch, Jonas; Cathomas, Richard; Cavallin‐Ståhl, Eva; Clarke, Noel W.; Claßen, Johannes; Cohn‐Cedermark, Gabriella; Dahl, Alv A.; Daugaard, Gedske; Giorgi, Ugo De; Santis, Maria De; Wit, Maike de; Wit, Ronald de; Dieckmann, K.-P.; Fenner, Martin; Fizazi, Karim; Fléchon, Aude; Fosså, Sophie D.; Lluch, Josep Ramon Germà; Gietema, Jourik A.; Gillessen, Silke; Giwercman, A.; Hartmann, Jörg T.; Heidenreich, Axel; Hentrich, Marcus; Honecker, Friedemann; Horwich, A.; Huddart, Robert; Kliesch, Sabine; Kollmannsberger, Christian; Krege, Susanne; Laguna, M. Pilar; Looijenga, Leendert H. J.; Lorch, Anja; Lotz, Jean‐Pierre; Mayer, Frank; Necchi, Andrea; Nicolai, Nicola; Nuver, Janine; Oechsle, Karin; Oldenburg, Jan; Oosterhuis, J. Wolter; Powles, Tom; Meyts, Ewa Rajpert‐De; Rick, Oliver; Rosti, Giovanni; Salvioni, Roberto; Schrader, Mark; Schweyer, Stefan; Sedlmayer, Felix; Sohaib, Aslam; Souchon, Rainer; Tandstad, Torgrim; Winter, Christian; Wittekind, Christian

doi:10.1093/annonc/mds579

Cited by 293 publications

(202 citation statements)

References 99 publications

(106 reference statements)

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“…3 Relapses are observed among $ 20% of patients who undergo active surveillance, particularly if risk factors for occult metastatic disease are present. Adjuvant treatment with either radiotherapy or carboplatin can substantially reduce this risk.…”

Section: Introductionmentioning

confidence: 99%

Outcome of Men With Relapse After Adjuvant Carboplatin for Clinical Stage I Seminoma

Fischer

Tandstad

Wheater

et al. 2017

JCO

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Purpose Adjuvant carboplatin is one of three management strategies that may follow inguinal orchiectomy in clinical stage I seminoma. However, little is known about the outcome of patients who experience a relapse after such treatment. Patients and Methods Data from 185 patients who relapsed after adjuvant carboplatin between January 1987 and August 2013 at 31 centers/groups from 20 countries were collected and retrospectively analyzed. Primary outcomes were disease-free survival and overall survival. Secondary outcomes were time to, stage at, and treatment of relapse as well as rate of subsequent relapses. Results With a median follow-up of 53 months (95% CI, 48 to 60 months) the 5-year diseasefree survival was 82% (95% CI, 77% to 89%), and the 5-year overall survival was 98% (95% CI, 95% to 100%). The median time from orchiectomy to relapse was 19 months (95% CI, 17 to 23 months); 15% (95% CI, 10% to 21%) of relapses occurred > 3 years after treatment. The majority of relapses were detected by computed tomography scan during routine follow-up, 98% in the International Germ Cell Cancer Collaborative Group good prognosis group. Chemotherapy was administered to 92% of patients, mostly as standard first-line treatment corresponding to stage; 8% of patients had additional local treatments. Only 28 patients experienced a second relapse. At last follow-up, 174 (94%) of 185 patients were alive without disease, and four patients with disease. Seven patients died, three of whom due to progressive disease. Conclusion Within the limitations of a retrospective analysis, the results suggest that the majority of patients who experience a relapse after adjuvant carboplatin for clinical stage I seminoma can be successfully treated with a cisplatin-based chemotherapy regimen adequate for stage. Because 15% of the relapses occurred > 3 years after adjuvant treatment, a minimum of 5 years follow-up is recommended. Patients and MethodsData from 185 patients who relapsed after adjuvant carboplatin between January 1987 and August 2013 at 31 centers/groups from 20 countries were collected and retrospectively analyzed. Primary outcomes were disease-free survival and overall survival. Secondary outcomes were time to, stage at, and treatment of relapse as well as rate of subsequent relapses. ResultsWith a median follow-up of 53 months (95% CI, 48 to 60 months) the 5-year disease-free survival was 82% (95% CI, 77% to 89%), and the 5-year overall survival was 98% (95% CI, 95% to 100%). The median time from orchiectomy to relapse was 19 months (95% CI, 17 to 23 months); 15% (95% CI, 10% to 21%) of relapses occurred . 3 years after treatment. The majority of relapses were detected by computed tomography scan during routine follow-up, 98% in the International Germ Cell Cancer Collaborative Group good prognosis group. Chemotherapy was administered to 92% of patients, mostly as standard first-line treatment corresponding to stage; 8% of patients had additional local treatments. Only 28 patients experienced a second relapse. At last ...

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Section: Introductionmentioning

confidence: 99%

Outcome of Men With Relapse After Adjuvant Carboplatin for Clinical Stage I Seminoma

Fischer

Tandstad

Wheater

et al. 2017

JCO

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“…All performed diagnostic and therapeutic approaches were in accordance with the latest guideline recommendations for patients with testicular cancer (7,8,9). All examinations and outcomes were prospectively and consecutively recorded.…”

Section: Methodsmentioning

confidence: 99%

Late relapse in stage I of nonseminomatous germ cell testicular cancer on surveillance

Ondrušová¹,

Suchansky²,

Psota³

et al. 2018

BLL

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OBJECTIVE: Primary aim was to assess relapse-free survival (RFS) in patients with clinical stage I (CS I) of non-seminomatous germ cell testicular tumors (NSGCTT) undergoing surveillance after orchiectomy. The secondary aim was to examine differences in risk factors in patients with early relapse (ER < 2 years), late relapse (LR > 2 years) and very late relapse (VLR > 5 years). METHODS: Cross-sectional study analyzed 25-year single-center experiences with 198 CS I NSGCTT patients according the time to relapse. RESULTS: RFS was 160/198 (80.8 %). Relapse occurred in 38 (19.2 %) patients after a median fol low-up of 7.57 months, 33 (86.8 %) patients had ER after a median follow-up of 7.03 months and 5 patients had LR (13.2 %) after a median follow-up of 26.28 months. One patient (2.63 %) had VLR after follow-up > 5 years (7.17 years). Three relapsed patients died with metastatic disease after a mean follow-up of 5.1 years from the date of diagnosis. Another three patients died without cancer after a mean follow-up of two years. OS was 192/198 (97 %). CONCLUSION: Diagnosis and treatment of late relapsing NSGCTT patients should be performed in experienced centers only. Occurrence of LR is the reason for long-term monitoring of NSGCTT survivors (Tab. 1, Fig. 1, Ref. 14). Text in PDF www.elis.sk.

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“…Testicular germ cell tumors (GCTs) accounts for only 1-2% of all male neoplasma but GCTs are the most common cancer of young men with the highest incidence in patients aged 15 to 40 years (Devesa et al, 1995;Beyer et al, 2013;Siegel et al, 2013). According to their histological features and serum tumor markers level GCTs are mainly divided into two groups: seminomas (30-45%) and nonseminomas (55-70%).…”

Section: Introductionmentioning

confidence: 99%

“…GCTs are model for curable solid tumors for more than three decades (Einhorn and Donohue, 1977; S. D. Williams et al, 1987). More than 90% of patients, including those with disseminated disease, are cured with surgery, radiotherapy, and chemotherapy alone or combination of them (Krege et al, 2008;Motzer et al, 2012;Beyer et al, 2013;Siegel et al, 2013). Despite high cure rate, long-term disease free survival (DFS) cannot be achieved in 5-10% of patients and optimal salvage chemotherapy is still unknown for them (Motzer et al, 2012;Beyer et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

“…More than 90% of patients, including those with disseminated disease, are cured with surgery, radiotherapy, and chemotherapy alone or combination of them (Krege et al, 2008;Motzer et al, 2012;Beyer et al, 2013;Siegel et al, 2013). Despite high cure rate, long-term disease free survival (DFS) cannot be achieved in 5-10% of patients and optimal salvage chemotherapy is still unknown for them (Motzer et al, 2012;Beyer et al, 2013). In this retrospective study, our aim was to evaluate clinicopathological features, risk factors, treatment responses, and survival analysis of patient with advanced NSGCTs.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Outcome in Patients with Advanced Nonseminomatous Germ Cell Testicular Tumors

Yetişyiğit

Babacan²,

Ürün³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: Predictor factors determining complete response to treatment are still not clearly defined. We aimed to evaluate clinicopathological features, risk factors, treatment responses, and survival analysis of patient with advanced nonseminomatous GCTs (NSGCTs). Materials and Methods: Between November 1999 and September 2011, 140 patients with stage II and III NSGCTs were referred to our institutions and 125 patients with complete clinical data were included in this retrospective study. Four cycles of BEP regimen were applied as a first-line treatment. Salvage chemotherapy and/or high-dose chemotherapy (HDCT) with autologous stem cell transplantation were given in patients who progressed after BEP chemotherapy. Post-chemotherapy surgery was performed in selected patients with incomplete radiographic response and normal tumor markers. Results: The median age was 28 years. For the good, intermediate and poor risk groups, compete response rates (CRR) were, 84.6%, 67.9% and 59.4%, respectively. Extragonadal tumors, stage 3 disease, intermediate and poor risk factors, rete testis invasion were associated with worse outcomes. There were 32 patients (25.6%) with non-CR who were treated with salvage treatment. Thirty-one patients died from GCTs and 94% of them had stage III disease. Conclusions: Even though response rates are high, some patients with GCTs still need salvage treatment and cure cannot be achieved. Non-complete response to platinium-based first-line treatment is a negative prognostic factor. Our study confirmed the need for a prognostic and predictive model and more effective salvage approaches.

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Maintaining success, reducing treatment burden, focusing on survivorship: highlights from the third European consensus conference on diagnosis and treatment of germ-cell cancer

Cited by 293 publications

References 99 publications

Outcome of Men With Relapse After Adjuvant Carboplatin for Clinical Stage I Seminoma

Outcome of Men With Relapse After Adjuvant Carboplatin for Clinical Stage I Seminoma

Late relapse in stage I of nonseminomatous germ cell testicular cancer on surveillance

Predictors of Outcome in Patients with Advanced Nonseminomatous Germ Cell Testicular Tumors

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