Annals of Oncology Advance Access originally published online on November 15, 2007
Annals of Oncology 2008 19(3):448-453; doi:10.1093/annonc/mdm526
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urogenital tumors |
Combination chemotherapy with gemcitabine, oxaliplatin, and paclitaxel in patients with cisplatin-refractory or multiply relapsed germ-cell tumors: a study of the German Testicular Cancer Study Group
1 Department of Oncology/Hematology with sections Bone Marrow Transplantation and Pneumology, University Medical Centre Eppendorf, Hamburg, Germany
2 Divisions of Medical Oncology, British Columbia Cancer Agency, Vancouver Cancer Centre, University of British Columbia, Vancouver, Canada
3 Department of Oncology/Hematology/Immunology/Rheumatology, University of Tuebingen, Medical Centre, Tuebingen
4 Department of Hematology/Oncology, University of Freiburg, Freiburg, Germany
* Correspondence to: Dr C. Kollmannsberger, Division of Medical Oncology, British Columbia Cancer Agency, Vancouver Cancer Centre, University of British Columbia, 600 West 10th Avenue, Vancouver, British Columbia V5Z 4E6, Canada. Tel: +1 604-877-6000; Fax: +1 604-708-2144; E-mail: ckollmannsberger{at}bccancer.bc.ca
Background: The aim of this study is to determine feasibility and efficacy of the combination regimen gemcitabine, oxaliplatin, and paclitaxel (GOP) in patients with cisplatin-refractory or multiply relapsed germ-cell tumors.
Patients and methods: From April 2003 to October 2006, 41 patients refractory to cisplatin-based chemotherapy or with relapse after high-dose chemotherapy (HDCT) plus stem-cell support (peripheral blood stem-cell transplantation: PBSCT) received 800 mg/m2 gemcitabine, 80 mg/m2 paclitaxel (Taxol), both on days 1 + 8, and oxaliplatin 130 mg/m2 on day 1 of a 3-week cycle for a minimum of two cycles. Primary end point was response rate. Patients were pretreated with a median of two lines of platin-based chemotherapy (range, 1–3), and 78% had relapsed after HDCT/PBSCT.
Results: Seventy-three percent of patients had relapsed within 3 months after the last cisplatin-based chemotherapy. Five percent of the patients achieved a complete response, and 34% and 12% a marker-negative and marker-positive partial response, respectively (overall response rate 51%). After a median follow-up of 5 months (range, 0–20), 15% of the patients remain in complete remission after GOP chemotherapy ± residual tumor resection with a median response duration of 8 months (1 to 17+). Main toxicity was leucocytopenia grade 3/4 in 15%, anemia in 7%, and thrombocytopenia in 49% of the patients.
Conclusion: Combination chemotherapy with GOP is feasible and effective with acceptable toxicity in patients with treatment-refractory germ-cell tumors.
Key words: cisplatin refractory, gemcitabine, germ-cell tumor, oxaliplatin, paclitaxel, relapsed
These authors contributed equally to this work. Received for publication August 20, 2007. Revision received October 10, 2007. Accepted for publication October 15, 2007.