Carsten Bokemeyer, MD, Professor of Internal Medicine at the University Medical Center Hamburg, Germany, formally discussed the paper by Fizazi et al at the ASCO Annual Meeting. “This is a positive trial. The progression-free survival, the primary endpoint, showed a 10% improvement, though, unfortunately, the overall survival was not significantly positive,” he said.
“This is the first randomized trial showing an effect of dose intensification in slow marker-declining patients and confirms data from subset analyses of other trials in the poor-risk setting,” Dr. Bokemeyer noted.
“I congratulate the investigators for doing this trial. Coming up with these data is extremely important, and was not easy to do,” he acknowledged. “It clearly also shows the importance of marker declines as a prognostic on-treatment factor … The fact that marker declines can be assessed after one cycle of BEP is important, as this allows us to change treatment early.”
Alternative Regimens
He noted, however, that the dose-dense chemotherapy regimen in this study is unfamiliar to most oncologists, and suggested other options worthy of study: a high-dose regimen that includes carboplatin, etoposide, and cyclophosphamide, which is used at Memorial Sloan-Kettering Cancer Center; accelerated BEP, which is used in Australia; a regimen known as PEI (cisplatin, etoposide, ifosfamide), as used by the European Organisation for Research and Treatment of Cancer; and one called TIP (paclitaxel, ifosfamide, cisplatin), which showed some promise in another study presented at this year’s ASCO Annual Meeting.1
Considering that treatment intensification approaches are different around the world, Dr. Bokemeyer added, “With regard to guideline inclusion, we need more than one discussant from one country.” ■
Disclosure: Dr. Bokemeyer has received honoraria or consultation fees from and is an advisor for Merck Serono, Roche, and GlaxoSmithKline.
Reference
1. Feldman DR, Hu J, Dorff TB, et al: 2013 ASCO Annual Meeting. Abstract 4501. Presented June 1, 2013.
