Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA.
Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA.
Oncologist. 2021 Jun;26(6):483-491. doi: 10.1002/onco.13719. Epub 2021 Mar 12.
The National Comprehensive Cancer Network recommends either three cycles of bleomycin, etoposide, and cisplatin or four cycles of etoposide and cisplatin (EPx4) as initial chemotherapy for the treatment of good-risk germ cell tumors (GCTs). To assess the response, toxicity, and survival outcomes of EPx4, we analyzed our experience.
Response and survival outcomes, selected toxicities, and adherence to chemotherapy dose and schedule were assessed in patients with good-risk GCT who received EPx4 at Memorial Sloan Kettering Cancer Center between 1982 and 2016. The results were compared with our past results and published data.
Between 1982 and 2016, 944 patients with GCT were treated with EPx4, 289 who were previously reported plus 655 treated between January 2000 and August 2016. A favorable response was achieved in 928 of 944 patients (98.3%). Five-year progression-free, disease-specific, and overall survival rates were 93.9%, 98.6%, and 97.9%, respectively. Median follow-up was 7.3 years (range, 2.8 months to 35.5 years). Viable, nonteratomatous malignant GCT was present in 3.5% of 432 postchemotherapy retroperitoneal lymph node dissection specimens from patients with nonseminomatous GCT. Febrile neutropenia and thromboembolic events occurred in 16.0% and 8.9%, respectively, with one treatment-related death. In the more recent 655-patient cohort, full-dose EPx4 was administered to 631 (96.3%), with deviations from planned treatment driven mainly by vascular (n = 13), hematologic (n = 11), renal (n = 7), or infectious (n = 5) events.
EPx4 is highly effective and well tolerated in patients with good-risk GCTs and remains a standard of care.
Four cycles of etoposide and cisplatin (EPx4) is a standard-of-care regimen for all patients with good-risk germ cell tumors with a favorable response rate and disease-specific survival of 98%. Full-dose administration of etoposide and cisplatin and complete resection of residual disease lead to optimal outcomes. EPx4 should be the recommended regimen in active smokers, patients with reduced or borderline kidney function, and patients aged 50 years or older, which are patient groups at increased risk for bleomycin pulmonary toxicity. Because of a risk of acquired severe pulmonary illness, EPx4 may also be favored for patients who vape or use e-cigarettes and during ongoing transmission of severe acute respiratory syndrome coronavirus 2.
美国国家综合癌症网络建议将博来霉素、依托泊苷和顺铂治疗 3 个周期或依托泊苷和顺铂（EPx4）治疗 4 个周期作为治疗低危生殖细胞肿瘤（GCT）的初始化疗。为了评估 EPx4 的反应、毒性和生存结果，我们分析了我们的经验。
1982 年至 2016 年间，在纪念斯隆凯特琳癌症中心接受 EPx4 治疗的低危 GCT 患者中，评估了其反应和生存结果、选择毒性、以及对化疗剂量和方案的依从性。将结果与我们过去的结果和已发表的数据进行了比较。
1982 年至 2016 年间，944 例 GCT 患者接受了 EPx4 治疗，其中 289 例为既往报道的患者，655 例为 2000 年 1 月至 2016 年 8 月期间接受治疗的患者。944 例患者中 928 例（98.3%）获得了良好的反应。5 年无进展、疾病特异性和总生存率分别为 93.9%、98.6%和 97.9%。中位随访时间为 7.3 年（范围 2.8 个月至 35.5 年）。在 432 例非精原细胞瘤性 GCT 患者的化疗后腹膜后淋巴结清扫标本中，有 3.5%的标本存在有活力的、非畸胎瘤性恶性 GCT。发热性中性粒细胞减少症和血栓栓塞事件分别发生在 16.0%和 8.9%的患者中，有 1 例与治疗相关的死亡。在最近的 655 例患者队列中，631 例（96.3%）接受了全剂量 EPx4 治疗，主要由血管（n = 13）、血液学（n = 11）、肾脏（n = 7）或感染（n = 5）事件导致偏离计划治疗。
EPx4 对低危 GCT 患者非常有效且耐受性良好，仍然是一种标准的治疗方法。
对于所有低危生殖细胞肿瘤患者，4 个周期的依托泊苷和顺铂（EPx4）是标准的治疗方案，其反应率和疾病特异性生存率为 98%。依托泊苷和顺铂的全剂量给药和残余疾病的完全切除可带来最佳结果。EPx4 应作为主动吸烟者、肾功能降低或临界肾功能患者以及 50 岁或以上患者的推荐方案，这些患者因博来霉素肺毒性而处于较高风险。由于存在获得性严重肺部疾病的风险，因此对于使用电子烟或电子香烟的患者以及在严重急性呼吸综合征冠状病毒 2 持续传播期间，EPx4 也可能是首选方案。
