Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Clin Genitourin Cancer. 2021 Feb;19(1):e6-e11. doi: 10.1016/j.clgc.2020.05.014. Epub 2020 Jun 2.
Second-line salvage therapy for patients with metastatic germ-cell cancer (GCC) after the first-line combination of VIP (etoposide, ifosfamide, cisplatin) therapy has not been established. This study evaluated the efficacy and tolerability of the TGP (paclitaxel, gemcitabine, cisplatin) combination chemotherapy as a second-line salvage therapy.
The medical records of 16 consecutive patients with metastatic GCC who had been treated with first-line VIP therapy followed by second-line TGP therapy between 2005 and 2019 were reviewed and statistically analyzed. Ten patients, excluding the 6 patients treated with TGP without unequivocal progression, were included in the efficacy analysis. All 16 patients were included in the safety analysis.
The median follow-up period from initial TGP administration was 78 months (interquartile range, 46-120 months). The estimated 5-year progression-free and overall survival rates for the 10 patients in the efficacy analysis were 70% and 100%, respectively. Grade 3/4 hematologic toxicity occurred in all 16 patients, but none developed uncontrollable infections or life-threatening bleeding. One patient died of treatment-related secondary leukemia, however.
The present study is to our knowledge the first to examine the therapeutic outcomes and safety profile of second-line TGP chemotherapy. VIP followed by TGP might be an alternative first- and second-line conventional regimen for patients with metastatic GCC in this granulocyte colony-stimulating factor era, especially for patients at a high risk of bleomycin-induced pulmonary toxicity.
在一线 VIP（依托泊苷、异环磷酰胺、顺铂）治疗后，转移性生殖细胞瘤（GCC）患者的二线挽救治疗尚未确立。本研究评估了 TGP（紫杉醇、吉西他滨、顺铂）联合化疗作为二线挽救治疗的疗效和耐受性。
回顾性分析了 2005 年至 2019 年间接受一线 VIP 治疗后接受二线 TGP 治疗的 16 例转移性 GCC 患者的病历，并进行了统计学分析。排除 6 例 TGP 治疗无明确进展的患者后，10 例患者纳入疗效分析。所有 16 例患者均纳入安全性分析。
从初始 TGP 给药开始的中位随访时间为 78 个月（四分位距，46-120 个月）。10 例疗效分析患者的 5 年无进展生存率和总生存率分别为 70%和 100%。16 例患者均出现 3/4 级血液学毒性，但均未发生无法控制的感染或危及生命的出血。然而，1 例患者死于治疗相关的继发性白血病。
本研究首次评估了二线 TGP 化疗的治疗效果和安全性。在粒细胞集落刺激因子时代，VIP 后继以 TGP 可能是转移性 GCC 患者的一线和二线常规治疗方案的一种选择，特别是对于有博来霉素诱导的肺毒性高危风险的患者。
