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Salvage chemotherapy with paclitaxel and gemcitabine plus nedaplatin (TGN) as part of multidisciplinary therapy in patients with heavily pretreated cisplatin-refractory germ cell tumors

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Abstract

Background

We investigated the efficacy and toxicity of a regimen consisting of paclitaxel and gemcitabine plus nedaplatin, a derivative of cisplatin (TGN) in patients with heavily pretreated cisplatin-refractory germ cell tumors (GCTs).

Methods

Fifteen patients with advanced GCTs were treated with the TGN regimen. The combination chemotherapy consisted of paclitaxel (210 mg/m2) on day 1 and gemcitabine (1000 mg/m2) on days 1 and 8 in combination with nedaplatin (100 mg/m2) on day 2 every 3 weeks.

Results

Patients enrolled in this study had been heavily pretreated with a median of 12 platinum-containing cycles (range, 7 to 26 cycles). Most of the regimens had included paclitaxel and ifosfamide plus cisplatin or nedaplatin (TIP/TIN) chemotherapy. The median follow-up period of the present study was 15 months. Patients received 2–11 cycles of the TGN combination chemotherapy. Six patients received the treatment combined with other therapeutic modalities; 2 patients received radiation therapy for retroperitoneal lymph node metastasis, 1 patient had cyber-knife radiosurgery for brain metastasis and 3 patients had radiofrequency ablation for liver and lung metastasis. Seven (46.7%) of the 15 patients achieved an objective response; 6 had marker-negative partial responses (PRs) and 1 had a marker-positive PR. Two (13%) of the 7 patients with PRs achieved a disease-free status after chemotherapy combined with RT and followed by surgical resection. However, 10 patients died of the disease and 3 patients are still alive with the disease.

Conclusion

The TGN regimen alone had limited efficacy in this patient population, with severe but manageable toxicities. However, TGN chemotherapy may offer a chance of cure for some heavily pretreated cisplatin-refractory (TIP/TIN-refractory) patients as part of multidisciplinary therapy.

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Authors and Affiliations

  1. Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan

    Takumi Shiraishi, Terukazu Nakamura, Kazuya Mikami, Natsuki Takaha, Akihiro Kawauchi & Tsuneharu Miki

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  1. Takumi Shiraishi
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  2. Terukazu Nakamura
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  3. Kazuya Mikami
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  4. Natsuki Takaha
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  5. Akihiro Kawauchi
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  6. Tsuneharu Miki
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Correspondence to Tsuneharu Miki.

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Shiraishi, T., Nakamura, T., Mikami, K. et al. Salvage chemotherapy with paclitaxel and gemcitabine plus nedaplatin (TGN) as part of multidisciplinary therapy in patients with heavily pretreated cisplatin-refractory germ cell tumors. Int J Clin Oncol 14, 436–441 (2009). https://doi.org/10.1007/s10147-009-0899-y

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  • DOI: https://doi.org/10.1007/s10147-009-0899-y

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