A risk-adapted study of cisplatin and etoposide, with or without ifosfamide, in patients with metastatic seminoma: results of the GETUG S99 multicenter prospective study.
BACKGROUND
Whether patients with good prognosis and intermediate/poor prognosis advanced seminoma should be treated differently has not been defined.


OBJECTIVE
To assess a risk-adapted chemotherapy regimen in patients with advanced seminoma.


DESIGN, SETTING, AND PARTICIPANTS
A total of 132 patients were included in this prospective study. Patients with a good prognosis according to the International Germ Cell Cancer Collaboration Group (IGGCCG) were treated with four cycles of cisplatin-etoposide (EP). Patients with an intermediate prognosis according to the IGCCCG (or a poor prognosis according to the Medical Research Council classification) were treated with four cycles of VIP (EP and ifosfamide) and granulocyte colony-stimulating factor (G-CSF).


OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Survival curves were estimated using the Kaplan-Meier method.


RESULTS AND LIMITATIONS
The median follow-up was 4.5 yr (range: 0.4-11.6 yr). Among 108 patients (82%) with a good prognosis who received EP, grade 3-4 toxicity included neutropenia (47%) and neutropenic fever (12%). Among the 24 patients (18%) with an intermediate/poor prognosis who received VIP plus G-CSF, toxicity included grade 3-4 neutropenia (36%), neutropenic fever (23%), thrombocytopenia (23%), anemia (23%), and a toxicity-related death (n=1; 4%). The 3-yr progression-free survival (PFS) rate was 93% (range: 85-97%) in the good prognosis group and 83% (range: 63-93%) in the intermediate/poor prognosis group (p=0.03 for PFS). The 3-yr overall survival (OS) rate was 99% (range: 92-100%) and 87% (range: 67-95%), respectively (p<0.005 for OS). Only four patients died of seminoma or its treatment.


CONCLUSIONS
A risk-adapted chemotherapy policy for advanced seminoma yielded an excellent outcome with a 3-yr OS rate of 96%.
['Fizazi|Karim|K|', 'Delva|Rémi|R|', 'Caty|Armelle|A|', 'Chevreau|Christine|C|', 'Kerbrat|Pierre|P|', 'Rolland|Frederic|F|', 'Priou|Frank|F|', 'Geoffrois|Lionnel|L|', 'Rixe|Olivier|O|', 'Beuzeboc|Philippe|P|', 'Malhaire|Jean-Pierre|JP|', 'Culine|Stephane|S|', 'Aubelle|Marie-Stephanie|MS|', 'Laplanche|Agnes|A|']
D000328:Adult D000368:Aged D000818:Animals D000971:Antineoplastic Combined Chemotherapy Protocols D002945:Cisplatin D018572:Disease-Free Survival D005047:Etoposide D005602:France D016179:Granulocyte Colony-Stimulating Factor D006801:Humans D007069:Ifosfamide D053208:Kaplan-Meier Estimate D008297:Male D008875:Middle Aged D011446:Prospective Studies D012307:Risk Factors D018239:Seminoma D013736:Testicular Neoplasms D013997:Time Factors D016896:Treatment Outcome D055815:Young Adult
Seminoma Chemotherapy Prognostic factors