Loriot Y, Pagliaro L, Fléchon A, Mardiak J, Geoffrois L, Kerbrat P, Chevreau C, Delva R, Rolland F, Theodore C, Roubaud G, Gravis G, Eymard J C, Malhaire J P, Linassier C, Habibian M, Martin A L, Journeau F, Reckova M, Logothetis C, Laplanche A, Le Teuff G, Culine S, Fizazi K
Gustave Roussy, Université Paris-Saclay, Département de Médecine Oncologique, Villejuif, F-94805, France.
Mayo Clinic College of Medicine, Mayo Clinic Cancer Center, Rochester, MN, USA.
Eur J Cancer. 2017 Dec;87:140-146. doi: 10.1016/j.ejca.2017.09.029. Epub 2017 Nov 14.
The GETUG 13 phase III trial tested personalised chemotherapy based on tumour marker decline in patients with poor-prognosis germ-cell tumour (GCT) and demonstrated that a dose-dense regimen improves progression-free survival in patients with an unfavourable decline. We investigated the pattern of relapse for patients included in GETUG 13.
We conducted an analysis of relapse events in patients from GETUG 13. Baseline procedures before inclusion in the trial comprised a thoraco-abdomino-pelvic computed tomography scan and a magnetic resonance imaging of the brain.
With a median follow-up of 4.1 years (0.3; 8.8 years), a progression event was observed in 109/254 patients (43%). First event consisted in a marker progression only in 47 patients (43%), a radiographic progression only in 35 patients (32%), a mix progression on both markers and imaging in 12 patients (11%) and death in 15 patients (14%). In patients with radiographic progression only, brain was the predominant site (n = 19/35, 54%). Among patients with unfavourable decline who experienced a radiographic progression (as first and subsequent progression event, n = 58), brain was a site of progression in 28 patients (48%): 12/30 (40%) in patients treated with cisplatin, bleomycin and etoposide and 16/28 (57%) in those treated with dose-dense chemotherapy.
Brain metastases develop often, early and frequently as the only site of relapse in the course of poor-prognosis GCT. This raises the question of early detection and optimal treatment of brain metastases in these patients, e.g. by integrating a systematic brain MRI after 2-3 months of chemotherapy.
GETUG 13 III期试验对预后不良的生殖细胞肿瘤（GCT）患者基于肿瘤标志物下降情况进行个体化化疗，并证明剂量密集方案可改善肿瘤标志物下降不利患者的无进展生存期。我们研究了GETUG 13纳入患者的复发模式。
我们对GETUG 13患者的复发事件进行了分析。纳入试验前的基线检查包括胸腹部盆腔计算机断层扫描和脑部磁共振成像。
中位随访4.1年（0.3；8.8年），254例患者中有109例（43%）出现进展事件。首次事件仅为标志物进展的有47例患者（43%），仅为影像学进展的有35例患者（32%），标志物和影像学均有进展的有12例患者（11%），死亡15例患者（14%）。仅出现影像学进展的患者中，脑部是主要部位（n = 19/35，54%）。在经历影像学进展（作为首次及后续进展事件，n = 58）的肿瘤标志物下降不利的患者中，28例患者（48%）脑部出现进展：接受顺铂、博来霉素和依托泊苷治疗的患者中有12/30（40%），接受剂量密集化疗的患者中有16/28（57%）。
在预后不良的GCT病程中，脑转移瘤常较早出现，且经常是唯一的复发部位。这就提出了这些患者脑转移瘤的早期检测和最佳治疗问题，例如在化疗2 - 3个月后进行系统性脑部MRI检查。
