SAN FRANCISCO, CA USA (UroToday.com) - Dr. Yohann Loriot presented an abstract on patterns of relapse in poor-prognosis germ cell tumors (GCT) in the GETUG 13 trial.
As a brief review, GETUG 13 trial, initially presented at ASCO 2013 by Fizazi et al., investigated personalized chemotherapy based on tumor marker decline in patients with poor-prognosis GCT, and showed that a dose-dense regimen improves progression-free survival in patients with an unfavorable decline. Before inclusion into the trial, at baseline, brain-thoraco-abdomino-pelvic cross sectional imaging showed 10% (22 patients) evidence of brain metastases at presentation. Dr. Loriot and colleagues conducted an analysis of relapse events in 203 patients from GETUG 13 to identify the pattern of relapse for these patients.
He reported that progression was observed in 94 patients (46%), at median follow-up of 4.1 years. He also reported that first event, consisting of a marker progression, was noted in 41 patients (43%), radiographic progression was noted in 29 patients (31%), and a mix progression on both markers and imaging in a total of 11 patients (12%). Brain was the predominant site of progression (seen in 55% of the patients) and mortality rate was reported at 14% (13) of the patients. Among the 52 patients who experienced a radiographic progression, brain-only was the site of progression in 26 patients (45%): 12/30 (40%) in patients treated with BEP and 14/28 (50%) in those treated with dose-dense chemotherapy.
This study raises concern that brain metastases develop often and early, as the only site of relapse in the course of poor-prognosis GCT. Perhaps more frequent and close follow-up with cross section of brain needs to be integrated into the follow-up protocol of these patients.
Highlights of a presentation by Yohann Loriot at the 2014 Genitourinary Cancers Symposium - January 30 - February 1, 2014 - San Francisco Marriott Marquis - San Francisco, California USA
Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France