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First‐line combination chemotherapy with etoposide, ifosfamide and cisplatin for the treatment of disseminated germ cell cancer: Efficacy and feasibility in current clinical practice
Author(s) -
Fujiwara Motohiro,
Tanaka Hajime,
Yuasa Takeshi,
Komai Yoshinobu,
Oguchi Tomohiko,
Fujiwara Ryo,
Numao Noboru,
Yamamoto Shinya,
Fujii Yasuhisa,
Fukui Iwao,
Yonese Junji
Publication year - 2021
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.14604
Subject(s) - medicine , ifosfamide , etoposide , chemotherapy , oncology , testicular cancer , cisplatin , germ cell tumors , neutropenia , pegfilgrastim , surgery , febrile neutropenia
Objectives To evaluate the efficacy and safety profiles of first‐line etoposide, ifosfamide and cisplatin and primary prophylaxis with pegfilgrastim as first‐line chemotherapy for disseminated germ cell cancer. Methods This study reviewed 154 consecutive patients with previously untreated disseminated germ cell cancer who received first‐line etoposide, ifosfamide and cisplatin between 1995 and 2020. Of these, 54 patients were managed with primary prophylaxis using pegfilgrastim (primary prophylaxis group), and 100 were managed with the therapeutic use of short‐acting granulocyte colony‐stimulating factor (non‐primary prophylaxis group). Results The International Germ Cell Cancer Collaborative Group classification identified 90 (58%)/40 (26%)/24 (16%) patients with good/intermediate/poor prognosis, respectively. Overall, 139 patients (90%) were disease free after etoposide, ifosfamide and cisplatin with/without post‐chemotherapy surgery. The median relative dose intensity of etoposide, ifosfamide and cisplatin was 96%, and there was a significant difference between the primary prophylaxis and non‐primary prophylaxis groups (100% vs 90%, P < 0.01). The 5‐year salvage treatment‐free and overall survival rates were 83% and 94%, respectively. In total, 138 patients (90%) developed grade 4 hematological toxicities, and there were no treatment‐related deaths due to myelosuppression. Grade 4 neutropenia was less commonly observed in the primary prophylaxis group compared with the non‐primary prophylaxis group (80% vs 95%, P < 0.01). Conclusions This is the largest study of first‐line etoposide, ifosfamide and cisplatin, and its sufficient efficacy and safety profiles are confirmed in current clinical practice. Primary prophylaxis using pegfilgrastim might further improve the feasibility of etoposide, ifosfamide and cisplatin.