This article is more than 5 years old. Information may no longer be current.
Cisplatin therapy effective for men with relapsed stage I seminoma
Click Here to Manage Email Alerts
Most men with stage I seminoma who relapsed after adjuvant carboplatin responded to cisplatin-based chemotherapy, a retrospective study in Switzerland found.
“After adjuvant carboplatin in clinical stage I seminoma, a relapse rate of approximately 4% to 9% has been reported,” Stefanie Fischer, MD, of the Cantonal Hospital St. Gallen, Switzerland, and colleagues wrote. “The timing and location, as well as the treatments and respective outcomes of such relapses, have not been exclusively studied so far. In particular, whether the prognosis of patients with relapse is compromised by previous adjuvant treatment remains unclear.”
Researchers collected data on 185 patients with stage I seminoma who relapsed after adjuvant carboplatin therapy between January 1987 and August 2013. Patients had received treatment at 31 centers in 20 different countries.
OS and DFS served as primary outcomes. Rate of subsequent relapses, stage at treatment, time to treatment and type of treatment served as secondary outcomes.
Median follow-up was 53 months. Median time to relapse was 19 months (95% CI, 71-23 months) and 118 relapses occurred within the first two years after carboplatin treatment (64%; 95% CI, 56-71). The earliest relapse came after four months, and the latest after 15 years. Another 39 relapses were reported between years 2 and 3 (21%; 95% CI, 15-28), and 28 more occurred after the three-year mark (15%; 95% CI, 10-21). Patients who underwent two cycles of adjuvant carboplatin had poorer DFS (HR = 2; 95% CI, 0.9-4.4), but this did not affect OS.
Five-year OS was 98% (95% CI, 95-100), and DFS was 82% (95% CI, 77-89). At the final follow-up, 94% of patients were alive (n = 174). Seven (3%) had died, three from progressing seminoma and two from treatment-related causes, including one instance of secondary leukemia. Two patients died of unrelated causes: myocardial infarction and chronic obstructive pulmonary disease.
Researchers added the study had “all the limitations of a retrospective analysis.
“However, for the first time in our knowledge, we demonstrate that adjuvant carboplatin is safe, even in patients who experience a relapse after such treatment,” Fischer and colleagues wrote. “The majority of patients with clinical stage I seminoma who experienced a relapse after adjuvant carboplatin could successfully undergo salvage therapy with excellent survival probabilities by using the treatment algorithms established for de novo metastatic disease.” – by Andy Polhamus
Disclosure: Fischer reports no relevant financial disclosures. Please see the study for a full list of all other researchers’ relevant financial disclosures.
Perspective
Back to Top
Patients with clinical stage 1 disease have a favorable outlook after orchiectomy, with a relapse rate of 15% to 20% and cause-specific deaths being rare. Adjuvant radiation was formerly used to reduce recurrence risk, but recognition of long-term toxicities caused a shift to surveillance. Adjuvant treatment with one or two doses of carboplatin emerged in the 1990s and was accepted by many as a standard of care option following the results of the MRC TE19 trial in 2004, demonstrating a relapse risk of approximately 5% with either single dose carboplatin at AUC = 7 or adjuvant radiation.
However, widespread adoption of this option raised several concerns about the fate of patients with subsequent relapses, many of which are now addressed by this retrospective review conducted by Dr. Stefanie Fischer and the Global Germ-Cell Cancer Group. They collected information about 185 relapses after adjuvant carboplatin from 31 centers. The most important finding is that only 3 patients clearly died from progressive cancer, addressing the fear that exposure to adjuvant carboplatin might select a more treatment-resistant phenotype at relapse. However, four patients were alive with disease and remain at risk. Next, the median time to relapse was 19 months with 15% occurring after 3 years, somewhat delayed compared to surveillance. This suggests a more prolonged follow-up plan may be required. A third observation is that 15% of the patients with relapses suffered a second relapse after salvage treatment. This is similar to treatment for de novo metastatic seminoma, but roughly 3 times as high as patients treated for relapse after surveillance. This may reflect selection bias but deserves further attention in larger cohorts. In summary, this is a valuable addition to our knowledge base and should be useful when counseling patients with CS1 seminoma about their options.
Click Here to Manage Email Alerts