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First salvage treatment of germ cell tumor patients with bone metastases: retrospective analysis of a large international database

  • Original Article – Clinical Oncology
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Abstract

Purpose

To retrospectively analyze clinical characteristics, prognostic factors, and optimal treatment of patients with bone metastases (BM) of germ cell tumors (GCT) at first relapse.

Methods

One hundred and four GCT patients with BM were identified from the IPFSG database containing 1,594 patients at first relapse. Within this database, all patients experienced unequivocal relapse/progression after cisplatin-based chemotherapy and had received either conventional (CD-CTX) or high-dose chemotherapy (HD-CTX) as first salvage treatment.

Results

At relapse, eight patients (8 %) had BM only, concomitant relapse with lung, brain, liver and/or nodal metastases were present in 40 (39 %), 6 (6 %), 27 (26 %), and 69 (66 %) pts, respectively. Patients clustered over all IPFSG subgroups, and the IPFSG score could be confirmed. Salvage treatment was CD-CTX in 35 and HD-CTX in 69 patients. Overall response (CR, PR) rate to salvage chemotherapy was 81 % (HD-CTX) versus 43 % (CD-CTX; p < 0.001). Median follow-up was 14 months (mos; range 1–161). Both, median PFS and OS, were higher after HD-CTX compared to CD-CTX [PFS 9 (95 % CI 6–12) vs. 5 (3–7) mos (p < 0.01); OS 18 (12–24) vs. 13 (8–18) mos (p = 0.078)].

Conclusions

GCT patients relapsing with BM have a dismal outcome. Retrospectively, first salvage HD-CTX seems to improve treatment response and outcome. Further evaluation of characteristics and treatment of GCT patients with BM is warranted.

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Acknowledgments

We are thankful for the contributions from pts, their families and participating investigators from 38 centers throughout Europe, Canada and the USA: A. Lorch, A. Neubauer (Marburg, Germany)(n = 270); J. Beyer, O. Rick (Berlin, Germany)(n = 157); L. Einhorn (Indiana, USA)(n = 151); A. Necchi, N. Nicolai, R. Salvioni (Milan, Italy)(n = 113); K. Fizazi, C. Massard (Paris Villejuif, France)(n = 108); the Italian Germ-Cell Cancer Group (U. De Giorgi, Lecce; M. Aieta, Rionero in Vulture; A. Chioni, Grosseto; R. De Vivo, Vicenza; G. Fornarini, Genova; G. Palmieri, Naples; G.L. Banna, S. Scandurra, Catania; M. Berretta, Aviano; S. Pessa, Treviso; C. Messina, Bergamo; F. Valcamonico, Brescia; P. Pedrazzoli, I. Schiavetto, Milan; C. Ortega, R. Vormola, Candiolo; G. Lo Re, S. Tumolo, Pordenone; U. Basso, Padua; T. Sava, Verona; F. Morelli, S. Giovanni Rotondo; L. Tedeschi, Milan; M. Simonelli, P. Zucali, Milan; G. Pizzocaro, Milan; all in Italy) (n = 82); H. Boyle, J.P. Droz, A. Fléchon (Lyon, France)(n = 80); K. Margolin, (Duarte, USA)(n = 52); A. Baron, J.P. Lotz (Paris Tenon, France)(n = 51); the Spanish Germ-Cell Cancer Group (A. Fernández, Albacete; J.R. Germà, P. Maroto, B. Mellado, Barcelona; P. Martínez del Prado, Bilbao; S. Vázquez, Lugo; J.A. Arranz, D. Castellanos, J. Sastre, Madrid; J. Terrasa, Mallorca; E. González, Murcia; N. Lainez, Navarra; M. Sánchez, San Sebastián; J. Gumà, Tarragona; F.J. Dorta, Tenerife; D. Almenar, J. Aparicio, M.A. Climent, R. Gironés, Valencia; A. Saenz, Zaragoza; all in Spain)(n = 50); T. Powles, J. Shamash (London Bartholomews, UK)(n = 46); C. Kollmannsberger (Vancouver, Canada)(n = 45); J.T. Hartmann, F. Mayer (Tübingen, Germany)(n = 37); J. Kirby, B. Mead, P. Simmonds (Southampton, UK)(n = 32); C. Bokemeyer, F. Honecker, K. Oechsle (Hamburg, Germany)(n = 28); S. Fossa, J. Oldenburg (Oslo, Norway)(n = 28); S. Rodenhuis (Amsterdam, Netherlands)(n = 26); M. Fenner (Hannover, Germany)(n = 26); G. Papiani, G. Rosti (Ravenna, Italy)(n = 24); G. Bosl, D. Feldman, R. Motzer, S. Turkula (New York, USA)(n = 22); P. Savage (London Charing Cross, UK)(n = 17); T. Gauler (Essen, Germany)(n = 17); B. Hayes-Lattin, C. Moore, C. Nichols (Portland, USA)(n = 16); C. Rehmsmeier, W.E. Berdel (Muenster, Germany)(n = 16); M. DeSantis, D. Jahn-Kuch (Vienna, Austria)(n = 15); E. Cavallin-Stahl, G. Cohn-Cedermark (Lund, Stockholm, Sweden)(n = 15); O. Dahl (Bergen, Norway)(n = 15); C. Higano (Seattle, USA)(n = 14); G. Daugaard (Copenhagen, Denmark)(n = 13); M. Hentrich (Munich Harlaching, Germany)(n = 12); A. Dieing, C. Sammler (Berlin Charite, Germany)(n = 11); H. Wandt (Nürnberg, Germany)(n = 11); B. Metzner (Oldenburg, Germany)(n = 10); P. Schöffski (Leuven, Belgium)(n = 10); B. Binh, N. Houede (Bordeaux, France)(n = 9); A. Gerl (Munich, Germany)(n = 6); S. Gillessen (St. Gallen, Switzerland)(n = 2); R. Cathomas (Chur, Switzerland)(n = 2).

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Oncology, Hematology and Bone Marrow Transplantation, University Medical Center Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    Christoph Oing, Carsten Bokemeyer, Friedemann Honecker, Lars Arne Berger & Karin Oechsle

  2. Department of Urology, University Medical Center Düsseldorf, Düsseldorf, Germany

    Anja Lorch

  3. Tumor and Breast Center ZeTup, St. Gallen, Switzerland

    Friedemann Honecker

  4. Department of Oncology, University Medical Center Zürich, Zurich, Switzerland

    Jörg Beyer

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  1. Christoph Oing
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  2. Anja Lorch
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Correspondence to Christoph Oing.

Additional information

For the International Prognostic Factors Study Group (IPFSG).

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Oing, C., Lorch, A., Bokemeyer, C. et al. First salvage treatment of germ cell tumor patients with bone metastases: retrospective analysis of a large international database. J Cancer Res Clin Oncol 141, 923–931 (2015). https://doi.org/10.1007/s00432-014-1876-z

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  • DOI: https://doi.org/10.1007/s00432-014-1876-z

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