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Long‐term results of a combination of paclitaxel, cisplatin and gemcitabine for salvage therapy in male germ‐cell tumours
Author(s) -
Nicolai Nicola,
Necchi Andrea,
Gianni Luca,
Piva Luigi,
Biasoni Davide,
Torelli Tullio,
Stagni Silvia,
Milani Angelo,
Pizzocaro Giorgio,
Salvioni Roberto
Publication year - 2009
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2009.08453.x
Subject(s) - medicine , gemcitabine , chemotherapy , neutropenia , cisplatin , toxicity , surgery , paclitaxel , refractory (planetary science) , salvage therapy , oncology , combination chemotherapy , gastroenterology , urology , physics , astrobiology
OBJECTIVE To retrospectively review the long‐term activity, efficacy and toxicity of the combination of paclitaxel, cisplatin and gemcitabine (TPG) as third‐ or further‐line chemotherapy in patients with germ‐cell tumours (GCTs) who are not cured after at least two courses of standard‐dose chemotherapy, high‐dose chemotherapy or both. PATIENTS AND METHODS We evaluated 22 consecutive men treated between April 1999 and December 2000. Half of them were classified as absolutely refractory to cisplatin and a further two as refractory. The median (range) number of previous courses of chemotherapy was 8 (5–11). Treatment consisted of paclitaxel 80 mg/m 2 , cisplatin 50 mg/m 2 and gemcitabine 800 mg/m 2 on days 1 and 8, every 3 weeks for four courses, followed by surgery of actual residual resectable masses. RESULTS The follow‐up was updated at August 2007. There were no deaths from toxicity and only one patient needed suspension of therapy for toxicity. There was both grade 3–4 thrombocytopenia and neutropenia in 15 patients (68%), and anaemia in nine (41%). There were partial remissions in eight (36%) patients. Six (27%) patients were rendered disease‐free with surgical removal of a residual mass after chemotherapy (two still containing viable cancer). Four (18%) patients are long‐term survivors at more than 80, 81, 94 and 99 months. The median (range) overall survival of the whole series was 13.5 (1–>99) months. CONCLUSION This combination had a toxicity profile that was acceptable and comparable with other third‐line regimens. There were eight (36%) major responses. After a 6‐year minimum follow‐up, four (18%) patients were long‐term disease‐free survivors.