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Relapse and Outcomes in Men Receiving Adjuvant Bleomycin/Etoposide/Cisplatin for Clinical Stage I Nonseminoma


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In a study reported in the Journal of Clinical Oncology, Fischer et al found different patterns of relapse and associated outcomes among men with relapse after treatment with adjuvant bleomycin/etoposide/cisplatin for clinical stage I nonseminoma.

The study included data on 51 patients from 18 centers in 11 countries who relapsed after orchiectomy and adjuvant bleomycin/etoposide/cisplatin for clinical stage I nonseminoma. Patients had a median age of 30.5 years at orchiectomy, and adjuvant chemotherapy was started at a median of 40 days after surgery. Overall and progression-free survival were calculated from day 1 of treatment at first relapse.

Key Findings 

Median follow-up was 96 months. Among all patients, 5-year progression-free survival was 67% and 5-year overall survival was 81%.

KEY POINTS

  • Median time to relapse was 13 months, with the earliest relapse occurring at 2 months after start of bleomycin/etoposide/cisplatin treatment and the latest after 25 years.
  • Overall, 63% of relapses occurred during the first 2 years after adjuvant treatment; 8% occurred between year 2 and 3, and 29% occurred at ≥ 3 years.
  • Overall, relapses could be categorized as: pure teratoma relapses treated with surgery alone; early nonseminoma relapses less than 2 years after adjuvant treatment; and late nonseminoma relapses more than 2 years after adjuvant treatment.

Median time to relapse was 13 months, with the earliest relapse occurring at 2 months after start of bleomycin/etoposide/cisplatin treatment and the latest after 25 years. Overall, 63% of relapses occurred during the first 2 years after adjuvant treatment; 8% occurred between year 2 and 3, and 29% occurred at ≥ 3 years.

Median time to relapse among patients relapsing with teratoma only was shorter than that among patients experiencing relapse with nonteratoma (9 vs 20 months, P < .001). A total of 10 patients (20%) had relapse more than 5 years after adjuvant treatment, and these relapses were associated with increased risk for subsequent progression or death (hazard ratio [HR] = 1.13 per year, P = .002) and increased risk for death (HR = 1.10 per year, P = .01).

After treatment for relapse, 15 patients (29%) experienced subsequent relapse; median time from first to subsequent relapse was 9 months. Death occurred in nine of these patients and was due to nonseminoma progression in eight.

Overall, relapses could be categorized as: pure teratoma relapses treated with surgery alone; early nonseminoma relapses less than 2 years after adjuvant treatment; and late nonseminoma relapses more than 2 years after adjuvant treatment. The nonseminoma-specific death rates in these three groups were 0%, 13%, and 28%, respectively.

The investigators concluded, “We report the first, to our knowledge, retrospective analysis focusing exclusively on patients with [clinical stage I nonseminoma] who were treated with adjuvant bleomycin/etoposide/cisplatin and who had an unequivocal relapse. The median time to relapse in this analysis was long, at 13 months, and approximately one-third of patients experienced relapse more than 3 years after adjuvant treatment…. We found a substantial rate of late and subsequent relapses. There seem to be three patterns of relapse with different outcomes: pure teratoma, early viable [nonseminoma] relapse (< 2 years), and late viable [nonseminoma] relapse (> 2 years).”

Silke Gillessen, MD, is the corresponding author for the Journal of Clinical Oncology article. 

Disclosure: The study was supported by a Swiss Group for Clinical Cancer Research/Astellas GU Oncology Award and by the Swiss Cancer League. For full disclosures of the study authors, visit ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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