Survival and Toxicity in Patients With Disseminated Germ CellCancer Aged 40 Years and Older

TY - JOUR

T1 - Survival and Toxicity in Patients With Disseminated Germ CellCancer Aged 40 Years and Older

AU - Thomsen, Frederik B

AU - Bandak, Mikkel

AU - Thomsen, Maria F

AU - Lauritsen, Jakob

AU - Christensen, Ib J

AU - Daugaard, Gedske

N1 - © 2013 American Cancer Society.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - BACKGROUND Germ-cell cancer (GCC) patients aged ≥40 years have a two-fold higher GCC-specific mortality. It has been hypothesized that reduced treatment intensity combined with increased treatment related toxicity could be the explanation. The objective was to analyze chemotherapy intensity, treatment related toxicity and survival in patients aged ≥40 years treated with standard chemotherapy for GCC compared with a younger control group that received similar treatment during the same period. METHODS From 1984 to 2011, 135 patients aged ≥40 years with disseminated GCC treated with bleomycin, etoposide and cisplatin (BEP). A control-group of 135 patients aged 18-35 years was randomly selected matched on year of BEP treatment. Cumulated doses of BEP as well as bone marrow toxicity, renal- and lung functions were recorded before, during and after termination of treatment. All patients were followed until death or October 1, 2011. RESULTS The cumulated doses of BEP were comparable between the two groups, however, more patients aged ≥40 years were reduced in bleomycin doses based on a decrease in carbon monoxide diffusion capacity corrected for haemoglobin (P = 0.03). No differences between the two groups were found regarding bone marrow toxicity or mean percentage changes in lung- or renal function. Patients aged ≥40 year had increased cancer specific mortality, HR = 4.8 (P = 0.005). In particular patients with disease progression after first line chemotherapy had increased mortality (P = 0.015). Moreover, the 5-year overall survival for patients aged ≥40 years was 82.5% compared to the expected 5-year survival of the background population of 96.3% (P <0.001). CONCLUSIONS Treatment related toxicity could not explain the increased cancer specific mortality in patients aged ≥40 years compared to a younger control-group, and while there were no differences in the administrated doses of cisplatin/etoposide, a decreased number of bleomycin doses were administered in the older patients. Apart from this, the inferior prognosis could be related to tumour biology, increased co-morbidity, or more severe toxicity in relation to second line treatment. Cancer 2014;120:43-51.

AB - BACKGROUND Germ-cell cancer (GCC) patients aged ≥40 years have a two-fold higher GCC-specific mortality. It has been hypothesized that reduced treatment intensity combined with increased treatment related toxicity could be the explanation. The objective was to analyze chemotherapy intensity, treatment related toxicity and survival in patients aged ≥40 years treated with standard chemotherapy for GCC compared with a younger control group that received similar treatment during the same period. METHODS From 1984 to 2011, 135 patients aged ≥40 years with disseminated GCC treated with bleomycin, etoposide and cisplatin (BEP). A control-group of 135 patients aged 18-35 years was randomly selected matched on year of BEP treatment. Cumulated doses of BEP as well as bone marrow toxicity, renal- and lung functions were recorded before, during and after termination of treatment. All patients were followed until death or October 1, 2011. RESULTS The cumulated doses of BEP were comparable between the two groups, however, more patients aged ≥40 years were reduced in bleomycin doses based on a decrease in carbon monoxide diffusion capacity corrected for haemoglobin (P = 0.03). No differences between the two groups were found regarding bone marrow toxicity or mean percentage changes in lung- or renal function. Patients aged ≥40 year had increased cancer specific mortality, HR = 4.8 (P = 0.005). In particular patients with disease progression after first line chemotherapy had increased mortality (P = 0.015). Moreover, the 5-year overall survival for patients aged ≥40 years was 82.5% compared to the expected 5-year survival of the background population of 96.3% (P <0.001). CONCLUSIONS Treatment related toxicity could not explain the increased cancer specific mortality in patients aged ≥40 years compared to a younger control-group, and while there were no differences in the administrated doses of cisplatin/etoposide, a decreased number of bleomycin doses were administered in the older patients. Apart from this, the inferior prognosis could be related to tumour biology, increased co-morbidity, or more severe toxicity in relation to second line treatment. Cancer 2014;120:43-51.

KW - Adult

KW - Age Factors

KW - Aged

KW - Antineoplastic Combined Chemotherapy Protocols

KW - Bleomycin

KW - Case-Control Studies

KW - Cisplatin

KW - Etoposide

KW - Humans

KW - Male

KW - Middle Aged

KW - Neoplasms, Germ Cell and Embryonal

KW - Prognosis

KW - Survival Analysis

KW - Treatment Outcome

U2 - 10.1002/cncr.28374

DO - 10.1002/cncr.28374

M3 - Journal article

C2 - 24108413

SN - 0008-543X

VL - 120

SP - 43

EP - 51

JO - Cancer

JF - Cancer

IS - 1

ER -