ABSTRACT
PURPOSE: Initial cisplatin (CIS) combination chemotherapy will cure 70% of patients with disseminated testicular cancer. This phase II clinical trial evaluated the combination of CIS plus epirubicin (CIS-EPI) in patients with metastatic germ cell tumors (GCT) not amenable to cure with standard salvage therapy. PATIENTS AND METHODS: Between March 2001 and August 2005, 30 patients with GCT, who had received at least one previous CIS-based regimen, were enrolled. All patients were males, with median age 36 (range, 24 to 45 years). Twenty-one patients (70%) had experienced late relapses (> 2 years). Patients received EPI 90 mg/m2 on day 1 and CIS 20 mg/m2 on days 1 to 5 every 3 weeks for maximum of four cycles. RESULTS: Nineteen (63%) of 30 patients received all four cycles. Toxicity was primarily hematologic: grade 3/4 neutropenia, four patients (one neutropenic fever); two patients had grade 3 thrombocytopenia, and five patients had grade 3/4 anemia. Nonhematologic toxicity was grade 3 acute renal failure in two patients; grade 3 electrolyte wasting in two patients; grade 3 nausea/vomiting in eight patients; grade 3 elevation of aminotransferases in one patient; and grade 3 diarrhea in one patient. There were no occurrences of severe mucositis, cardiotoxicity, or treatment-related deaths. Nine patients achieved a complete remission; seven of these patients remain without evidence of disease at 25+, 27+, 29+, 44+, 45+, 46+, and 48+ months. One patient remains alive with stable pulmonary nodules at 28+ months. CONCLUSION: CIS-EPI is an active regimen in metastatic GCT, with an acceptable toxicity profile. This regimen offers potential for long-term disease-free survival in this population.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Neoplasm Recurrence, Local/drug therapy , Neoplasms, Germ Cell and Embryonal/drug therapy , Adult , Cisplatin/administration & dosage , Disease-Free Survival , Epirubicin/administration & dosage , Humans , Male , Middle Aged , Neoplasms, Germ Cell and Embryonal/mortality , Neoplasms, Germ Cell and Embryonal/secondary , Salvage Therapy , Survival RateSubject(s)
Brain Neoplasms/diagnosis , Germinoma/diagnosis , Mediastinal Neoplasms/diagnosis , Neoplasms, Second Primary/diagnosis , Seminoma/diagnosis , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bleomycin/administration & dosage , Brain Neoplasms/therapy , Cisplatin/administration & dosage , Combined Modality Therapy , Etoposide/administration & dosage , Germinoma/therapy , Humans , Ifosfamide/administration & dosage , Male , Mediastinal Neoplasms/therapy , Neoplasm Recurrence, Local/diagnosis , Neoplasm Recurrence, Local/therapy , Neoplasms, Second Primary/therapy , Neurosurgical Procedures , Radiotherapy , Seminoma/therapy , Vinblastine/administration & dosageABSTRACT
Patients with advanced non-small cell lung cancer continue to have a poor prognosis; most die from the disease within 1 year. Chemotherapy is beneficial for some patients in the first-line metastatic setting. Three agents, namely docetaxel, pemetrexed, and erlotinib, are approved by the United States Food and Drug Administration as treatment in the second-line setting. In this article, we examine the data supporting the use of these agents in the second-line setting and review data from other completed trials. Lastly, we propose strategies to advance the treatment of patients with non-small cell lung cancer.
