Annals of Oncology Advance Access originally published online on May 25, 2008
Annals of Oncology 2008 19(8):1509; doi:10.1093/annonc/mdn371
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letters to the editors |
Does oxaliplatin and paclitaxel combination show an activity of some extent in pretreated patients with germ-cell tumors?
Reply to the article "A phase II multicenter study of oxaliplatin in combination with paclitaxel in poor prognosis patients who failed cisplatin-based chemotherapy for germ-cell tumors" by C. Theodore et al. (Ann Oncol 2008; doi: 10.1093/annonc/mdn122)
We have read with interest the article by Theodore et al. on the results of a combination of oxaliplatin and paclitaxel in a population of pretreated patients (pts) with germ-cell tumors (GCTs).We have some considerations regarding this study. First, information concerning cisplatin (CDDP) sensitivity is not clear, as a distinction between absolutely refractory and refractory patients is not reported in the text. This does not help in evaluating which could be the adequate setting for this therapy. However, 16 of 26 pts (61%) of the entire series demonstrated a CDDP refractoriness of some extent. The proportion fits literature data as a range of 36%–100% of these pts is reported in published series [1, 2].
Moreover, the authors gave a definition of poor prognosis relapses that is not commonly used; in our opinion, they have to be otherwise referred to as platinum-sensitive ones.
Oxaliplatin and paclitaxel are two of the new drugs that have been considered in salvage therapy for GCT. Different published double combinations gave results that ranged from 17% to 57% [3, 4], while maintained complete remissions lasting >1 year were between 6% and 23% [4, 5]. This experience is quite far from these results, as no complete responses or partial responses with normalized markers (PRm–) were achieved and only 7% of patients were long-term survivors following further rescues (i.e. high-dose chemotherapy and surgery, respectively). These results, although they may depend on specific unfavorable characteristics of the patients, would not allow the conclusion that ‘the combination may be effective if combined with additional treatment’. It would be more proper to state that a small subset of patients who had been treated with this combination could be rescued by further therapy.
1 Department of Medicine, Medical Oncology Unit 3
2 Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
* (E-mail: anynecchi{at}yahoo.it)
References
1. Hinton S, Catalano P, Einhorn LH, et al. Phase II study of paclitaxel plus gemcitabine in refractory germ cell tumors (E 9897): a trial of the Eastern Cooperative Oncology Group. J Clin Oncol (2002) 20:1859–1863.
2. Pectasides D, Pectasides M, Farmakis D, et al. Oxaliplatin and irinotecan plus granulocyte-colony stimulating factor as third-line treatment in relapsed or cisplatin-refractory germ-cell tumor patients: a phase II study. Eur Urol (2006) 46:216–221.[CrossRef]
3. De Giorgi U, Rosti G, Aieta M, et al. Phase II study of oxaliplatin and gemcitabine salvage chemotherapy in patients with cisplatin-refractory non-seminomatous germ cell tumor. Eur Urol (2006) 50:1032–1038.[CrossRef][Web of Science][Medline]
4. Bedano P, Brames M, Williams S, Einhorn L. A phase II study of cisplatin plus epirubicin salvage chemotherapy in refractory germ cell tumours. J Clin Oncol (2006) 24:5403–5407.
5. Kollmannsberger C, Beyer J, Liersch R, et al. Combination chemotherapy with gemcitabine plus oxaliplatin in patients with intensely pretreated or refractory germ cell cancer: a study of the German Testicular Cancer Study Group. J Clin Oncol (2004) 22:108–114.
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