Paclitaxel, ifosfamide, and cisplatin (TIP) as salvage and consolidation chemotherapy for advanced germ cell tumor

Abstract

Purpose The purpose of the study was to assess the efficacy of TIP as salvage chemotherapy for germ cell tumor (GCT) patients with relapsed disease or cisplatin (CDDP)-refractory disease and consolidation chemotherapy for patients who responded unfavorably to first-line chemotherapy.MethodsForty-three patients with advanced GCT were treated with TIP. Eleven with relapsed disease and five with CDDP-refractory disease received TIP as salvage chemotherapy. The remaining 27 received TIP as consolidation chemotherapy following initial induction chemotherapy. All patients received prophylactic granulocyte colony-stimulating factor.ResultsIn total, 116 cycles of TIP were administered with a median of three cycles (range 1–4 cycles) per patient. Before TIP, 33 patients showed elevated tumor marker and 23 patients (70 %) achieved marker normalization with the chemotherapy. One of six (17 %) patients with refractory disease and 5 of 10 (50 %) patients with relapsed disease achieved durable complete response (CR) after TIP with or without surgery. Eighteen of 27 (67 %) patients receiving TIP as consolidation chemotherapy achieved durable CR. Five additional patients were given further chemotherapy and achieved durable CR. Grade 4 leukocytopenia and thrombocytopenia were observed in 91 and 42 % of patients, respectively; all were managed with routine supportive care. Grade 2 and grade 3 sensory neuropathy was observed in 37 and 2 % of patients, respectively.ConclusionsThe TIP was effective for relapsed patients with favorable risk features and selected CDDP-refractory GCT patients. Results of TIP as consolidation for patients with unfavorable response to the initial chemotherapy were also encouraging. The toxicities were mainly myelosuppression and sensory neuropathy.

Testicular Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology

“…The conventional-dose regimens are TIP or VeIP. [109][110][111][112] The high-dose regimens include high-dose carboplatin plus etoposide followed by autologous stem cell transplant, 113 or paclitaxel plus ifosfamide followed by high-dose carboplatin plus etoposide with stem cell support (see TEST-F, page 1546). 114 Alternatively, surgical salvage may be considered if the recurrent mass is in a solitary resectable site.…”

Identification of a subgroup with worse prognosis among patients with poor‐risk testicular germ cell tumor

“…The most commonly used second-line chemotherapy regimen was a combination of taxanes, ifosfamide and platinum in 49 cases (66%), followed by other ifosfamide-containing regimens in 11 cases (15%). [13][14][15] Just six patients (8%) received HDCT as second-line chemotherapy.…”

Complete response to paclitaxel, ifosfamide, and cisplatin therapy in a case of ovarian ependymoma

“…HDCT is effective, but it has more side‐effects than conventional‐dose chemotherapy. On the other hand, toxicities of TIP are manageable in most patients . In addition, paclitaxel is one of the very few agents that are effective in MGCT patients with resistance to platinum even when it is used alone, and there are some reports that paclitaxel restores normal sensitivity to platinum …”