Testicular cancer

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Contents


Primary treatment

Carboplatin (Paraplatin)

Regimen #1, Oliver, et al. 2005 & 2011 - MRC TE19/EORTC 30982

one-time dose

Regimen #2, Aparicio, et al. 2011 - 2 doses carboplatin

Patients with stage I seminoma and local risk factors:

  1. Tumor >4 cm
  2. Rete testis invasion

Patients in Aparicio, et al. 2005 had at least one risk factor; patients in Aparicio, et al. 2011 had at both risk factors.

21-day cycles x 2 cycles

Supportive medications:

References

  1. Oliver RT, Mason MD, Mead GM, von der Maase H, Rustin GJ, Joffe JK, de Wit R, Aass N, Graham JD, Coleman R, Kirk SJ, Stenning SP; MRC TE19 collaborators and the EORTC 30982 collaborators. Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial. Lancet. 2005 Jul 23-29;366(9482):293-300. link to original article contains protocol PubMed
  2. Aparicio J, Germà JR, García del Muro X, Maroto P, Arranz JA, Sáenz A, Barnadas A, Dorca J, Gumà J, Olmos D, Bastús R, Carles J, Almenar D, Sánchez M, Paz-Ares L, Satrústegui JJ, Mellado B, Balil A, López-Brea M, Sánchez A; Second Spanish Germ Cell Cancer Cooperative Group. Risk-adapted management for patients with clinical stage I seminoma: the Second Spanish Germ Cell Cancer Cooperative Group study. J Clin Oncol. 2005 Dec 1;23(34):8717-23. Epub 2005 Oct 31. link to original article contains verified protocol PubMed
  3. Oliver RT, Mead GM, Rustin GJ, Joffe JK, Aass N, Coleman R, Gabe R, Pollock P, Stenning SP. Randomized trial of carboplatin versus radiotherapy for stage I seminoma: mature results on relapse and contralateral testis cancer rates in MRC TE19/EORTC 30982 study (ISRCTN27163214). J Clin Oncol. 2011 Mar 10;29(8):957-62. Epub 2011 Jan 31. link to original article contains protocol PubMed
  4. Aparicio J, Maroto P, del Muro XG, Gumà J, Sánchez-Muñoz A, Margelí M, Doménech M, Bastús R, Fernández A, López-Brea M, Terrassa J, Meana A, del Prado PM, Sastre J, Satrústegui JJ, Gironés R, Robert L, Germà JR. Risk-adapted treatment in clinical stage I testicular seminoma: the third Spanish Germ Cell Cancer Group study. J Clin Oncol. 2011 Dec 10;29(35):4677-81. doi: 10.1200/JCO.2011.36.0503. Epub 2011 Oct 31. link to original article contains verified protocol PubMed

EP

EP: Etoposide, Platinol

Regimen

21-day cycles x 4 cycles

References

  1. Xiao H, Mazumdar M, Bajorin DF, Sarosdy M, Vlamis V, Spicer J, Ferrara J, Bosl GJ, Motzer RJ. Long-term follow-up of patients with good-risk germ cell tumors treated with etoposide and cisplatin. J Clin Oncol. 1997 Jul;15(7):2553-8. link to original article contains protocol PubMed
  2. Kondagunta GV, Bacik J, Bajorin D, Dobrzynski D, Sheinfeld J, Motzer RJ, Bosl GJ. Etoposide and cisplatin chemotherapy for metastatic good-risk germ cell tumors. J Clin Oncol. 2005 Dec 20;23(36):9290-4. link to original article contains protocol PubMed

BEP

BEP: Bleomycin, Etoposide, Platinol

Regimen

21-day cycles x 3-4 cycles

Alternate schedule:

21-day cycles x 3-4 cycles

References

  1. Williams SD, Birch R, Einhorn LH, Irwin L, Greco FA, Loehrer PJ. Treatment of disseminated germ-cell tumors with cisplatin, bleomycin, and either vinblastine or etoposide. N Engl J Med. 1987 Jun 4;316(23):1435-40. link to original article contains protocol PubMed
  2. Saxman SB, Finch D, Gonin R, Einhorn LH. Long-term follow-up of a phase III study of three versus four cycles of bleomycin, etoposide, and cisplatin in favorable-prognosis germ-cell tumors: the Indian University experience. J Clin Oncol. 1998 Feb;16(2):702-6. link to original article contains protocol PubMed
  3. Nichols CR, Catalano PJ, Crawford ED, Vogelzang NJ, Einhorn LH, Loehrer PJ. Randomized comparison of cisplatin and etoposide and either bleomycin or ifosfamide in treatment of advanced disseminated germ cell tumors: an Eastern Cooperative Oncology Group, Southwest Oncology Group, and Cancer and Leukemia Group B Study. J Clin Oncol. 1998 Apr;16(4):1287-93. link to original article contains protocol PubMed
  4. de Wit R, Roberts JT, Wilkinson PM, de Mulder PH, Mead GM, Fosså SD, Cook P, de Prijck L, Stenning S, Collette L. Equivalence of three or four cycles of bleomycin, etoposide, and cisplatin chemotherapy and of a 3- or 5-day schedule in good-prognosis germ cell cancer: a randomized study of the European Organization for Research and Treatment of Cancer Genitourinary Tract Cancer Cooperative Group and the Medical Research Council. J Clin Oncol. 2001 Mar 15;19(6):1629-40. link to original article contains protocol PubMed
  5. Culine S, Kramar A, Théodore C, Geoffrois L, Chevreau C, Biron P, Nguyen BB, Héron JF, Kerbrat P, Caty A, Delva R, Fargeot P, Fizazi K, Bouzy J, Droz JP; Genito-Urinary Group of the French Federation of Cancer Centers Trial T93MP. Randomized trial comparing bleomycin/etoposide/cisplatin with alternating cisplatin/cyclophosphamide/doxorubicin and vinblastine/bleomycin regimens of chemotherapy for patients with intermediate- and poor-risk metastatic nonseminomatous germ cell tumors: Genito-Urinary Group of the French Federation of Cancer Centers Trial T93MP. J Clin Oncol. 2008 Jan 20;26(3):421-7. link to original article contains protocol PubMed

VIP

VIP: Vepesid, Ifosfamide, Platinol

Regimen

21-day cycles x 4 cycles

References

  1. Nichols CR, Catalano PJ, Crawford ED, Vogelzang NJ, Einhorn LH, Loehrer PJ. Randomized comparison of cisplatin and etoposide and either bleomycin or ifosfamide in treatment of advanced disseminated germ cell tumors: an Eastern Cooperative Oncology Group, Southwest Oncology Group, and Cancer and Leukemia Group B Study. J Clin Oncol. 1998 Apr;16(4):1287-93. link to original article contains protocol PubMed

Second line & later treatment

VeIP

VeIP: Velban, Ifosfamide, Platinol

Regimen

  • Vinblastine (Velban) 0.11 mg/kg IV on days 1-2
  • Ifosfamide (Ifex) 1200 mg/m2 IV on days 1-5
  • Mesna (Mesnex) 400 mg/m2 IV bolus on day 1 prior to first dose of ifosfamide, then Mesna (Mesnex) IV continuous infusion 1200 mg/m2/day on days to continue every 8 hours on days 1-5
  • Cisplatin (Platinol) 20 mg/m2 IV over 1 hour on days 1-5
  • Normal saline at rate of 100 mL/H continuous IV hydration on days 1-5

21-day cycles x 4 cycles

References

  1. Loehrer PJ Sr, Lauer R, Roth BJ, Williams SD, Kalasinski LA, Einhorn LH. Salvage therapy in recurrent germ cell cancer: ifosfamide and cisplatin plus either vinblastine or etoposide. Ann Intern Med. 1988 Oct 1;109(7):540-6. PubMed
  2. Loehrer PJ Sr, Gonin R, Nichols CR, Weathers T, Einhorn LH. Vinblastine plus ifosfamide plus cisplatin as initial salvage therapy in recurrent germ cell tumor. J Clin Oncol. 1998 Jul;16(7):2500-4. link to original article contains protocol PubMed

TIP

TIP: Taxol, Ifosfamide, Platinol

Regimen

21-day cycles x 4 cycles

References

  1. Kondagunta GV, Bacik J, Donadio A, Bajorin D, Marion S, Sheinfeld J, Bosl GJ, Motzer RJ. Combination of paclitaxel, ifosfamide, and cisplatin is an effective second-line therapy for patients with relapsed testicular germ cell tumors. J Clin Oncol. 2005 Sep 20;23(27):6549-55. link to original article contains protocol PubMed

High-dose Carboplatin (Paraplatin), Etoposide (Vepesid), stem cells

Regimen

  • Carboplatin (Paraplatin) 700 mg/m2 IV on 5, 4, and 3 days before peripheral blood stem cell infusion
  • Etoposide (Vepesid) 750 mg/m2 IV on 5, 4, and 3 days before peripheral blood stem cell infusion
  • At least 1 million CD34+ cells per kilogram of body weight was needed for each cycle of chemotherapy.

2 cycles, with the second cycle starting after "recovery of granulocyte and platelet counts"

"Most patients" who had complete or partial remission after two cycles of therapy then received:

28-day cycles x 3 cycles

References

  1. Einhorn LH, Williams SD, Chamness A, Brames MJ, Perkins SM, Abonour R. High-dose chemotherapy and stem-cell rescue for metastatic germ-cell tumors. N Engl J Med. 2007 Jul 26;357(4):340-8. link to original article contains protocol PubMed

TICE & stem cells

TICE: Taxol, Ifosfamide, Carboplatin, Etoposide

Regimen

  • Paclitaxel (Taxol) 200 mg/m2 IV over 24 hours on day 1
  • Ifosfamide (Ifex) 2000 mg/m2 IV over 4 hours on days 2-4
  • Mesna (Mesnex) with ifosfamide on days 2-4
  • Leukapheresis on days 11-13 (done on cycle 1, and then only if needed on cycle 2 to have at least 6 x 10^6 CD34+ cells/kg body weight in peripheral blood stem cells)

14-day cycles x 2 cycles

Then:

14-21 day cycles x 3 cycles

References

  1. Kondagunta GV, Bacik J, Sheinfeld J, Bajorin D, Bains M, Reich L, Deluca J, Budnick A, Ishill N, Mazumdar M, Bosl GJ, Motzer RJ. Paclitaxel plus Ifosfamide followed by high-dose carboplatin plus etoposide in previously treated germ cell tumors. J Clin Oncol. 2007 Jan 1;25(1):85-90. link to original article contains protocol PubMed

Cisplatin (Platinol) & Epirubicin (Ellence)

Regimen

21-day cycles x up to 4 cycles

References

  1. Bedano PM, Brames MJ, Williams SD, Juliar BE, Einhorn LH. Phase II study of cisplatin plus epirubicin salvage chemotherapy in refractory germ cell tumors. J Clin Oncol. 2006 Dec 1;24(34):5403-7. link to original article contains protocol PubMed

Gemcitabine (Gemzar) & Oxaliplatin (Eloxatin)

Regimen

21-day cycles x up to 6 cycles

References

  1. Pectasides D, Pectasides M, Farmakis D, Aravantinos G, Nikolaou M, Koumpou M, Gaglia A, Kostopoulou V, Mylonakis N, Skarlos D. Gemcitabine and oxaliplatin (GEMOX) in patients with cisplatin-refractory germ cell tumors: a phase II study. Ann Oncol. 2004 Mar;15(3):493-7. link to original article contains protocol PubMed

Gemcitabine (Gemzar) & Paclitaxel (Taxol)

Regimen

  • Gemcitabine (Gemzar) 1000 mg/m2 IV over 30 minutes on days 1, 8, 15
  • Paclitaxel (Taxol) 100-110 mg/m2 IV over 1 hour on days 1, 8, 15
  • Dexamethasone 20 mg PO/IV on days 1, 8, 15, prior to paclitaxel
  • Diphenhydramine 50 mg IV on days 1, 8, 15, prior to paclitaxel
  • Either cimetidine 300 mg IV or ranitidine 50 mg IV on days 1, 8, 15, 30-60 minutes before each dose of paclitaxel

28-day cycles x up to 6 cycles

References

  1. Einhorn LH, Brames MJ, Juliar B, Williams SD. Phase II study of paclitaxel plus gemcitabine salvage chemotherapy for germ cell tumors after progression following high-dose chemotherapy with tandem transplant. J Clin Oncol. 2007 Feb 10;25(5):513-6. link to original article contains protocol PubMed
  2. Hinton S, Catalano P, Einhorn LH, Loehrer PJ Sr, Kuzel T, Vaughn D, Wilding G. Phase II study of paclitaxel plus gemcitabine in refractory germ cell tumors (E9897): a trial of the Eastern Cooperative Oncology Group. J Clin Oncol. 2002 Apr 1;20(7):1859-63. link to original article contains protocol PubMed

Gemcitabine (Gemzar), Oxaliplatin (Eloxatin), Paclitaxel (Taxol)

Regimen

  • Gemcitabine (Gemzar) 800 mg/m2 IV over 30 minutes on days 1 & 8
  • Oxaliplatin (Eloxatin) 130 mg/m2 IV over at least 2 hours on day 1
  • Paclitaxel (Taxol) 80 mg/m2 IV over 1 hour on days 1 & 8
  • Dexamethasone 20 mg IV on days 1 & 8, 30 minutes prior to paclitaxel
  • Diphenhydramine 50 mg IV on days 1 & 8, 20 minutes prior to paclitaxel
  • Cimetidine 300 mg IV on days 1 & 8, 20 minutes prior to paclitaxel

21-day cycles x up to 8 cycles

References

  1. Bokemeyer C, Oechsle K, Honecker F, Mayer F, Hartmann JT, Waller CF, Böhlke I, Kollmannsberger C; German Testicular Cancer Study Group. Combination chemotherapy with gemcitabine, oxaliplatin, and paclitaxel in patients with cisplatin-refractory or multiply relapsed germ-cell tumors: a study of the German Testicular Cancer Study Group. Ann Oncol. 2008 Mar;19(3):448-53. Epub 2007 Nov 15. link to original article contains protocol PubMed
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