Survival and toxicity in patients with disseminated germ-cell cancer above 40 years of age.

Abstract

4532 Background: The aim was to analyze treatment related toxicity and survival in patients aged 40 years or above (40+) treated with standard chemotherapy for germ-cell cancer (GCC). Methods: The study population comprised 135 40+ patients with disseminated GCC treated between 1984 – 2011 with either 3 or 4 cycles bleomycin, etoposide and cisplatin (BEP). A control-group of 135 patients aged 18-35 years was randomly selected matched on year of BEP treatment. All patients were followed until death or October 1st2011. Cumulated doses of BEP as well as bone-marrow toxicity, renal- and lung functions were recorded before, during and after termination of treatment. The expected mortality was calculated by extracting survival data for each patient matched on the date and age at the time of diagnosis. The cause of death was categorized as GCC, other malignancy or other. Results: The cumulated doses of BEP were comparable between the two groups and, generally, BEP was equally well tolerated. 40+ patients had increased cancer specific mortality, HR = 4.8 (P = 0.005). Especially patients with disease progression after first line chemotherapy had increased mortality (P = 0.015). The year of treatment (P = 0.32), histology (P = 0.30), CCI (P = 0.99), tobacco use (P = 0.16), alcohol consumption (P = 0.21), prophylactic G-CSF (P = 0.61), reduced doses of bleomycin (P = 0.11) and decreased renal function (P = 0.18) were not significantly associated with GCC mortality. However, patients with impaired lung function (<80% of expected) prior to treatment had an increased risk of GCC mortality (FVC (P = 0.03), DLCO (P = 0.01) and FEV1(P = 0.05)). Moreover, the 5-year overall survival in the 40+ group was 82.5% compared to the expected 5-year survival of the background population of 96.2% (P <0.001) and the estimated 5-year survival of 97.0% in the control-group (P <0.001). Conclusions: Reduced treatment intensity, or treatment related toxicity could not explain the increased mortality in 40+ GCC patients compared to a younger control-group. The 40+ group has a significantly lower response rate to BEP and a significantly higher mortality in case of disease progression. The worse prognosis could be related to tumor biology or increased co-morbidity.