# GETUG 13: personalised chemotherapy based on tumour marker decline in poor-prognosis germ cell tumours

Source: https://onco.cc/key-papers/paper-getug-13-fizazi-lancet-oncol-2014/  
OnCo record `paper-getug-13-fizazi-lancet-oncol-2014` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

In poor-risk testicular cancer, men whose tumour markers fell slowly after the first cycle of BEP did better when switched to an intensified dose-dense regimen, the first trial to individualise chemotherapy by early marker response.

## Summary

Phase 3 trial of 263 men with poor-prognosis non-seminomatous germ cell tumours; those with unfavourable tumour marker decline after one cycle of BEP were randomised to continue BEP or switch to a dose-dense regimen (paclitaxel-BEP-oxaliplatin alternating with cisplatin-ifosfamide-bleomycin).

Three-year progression-free survival was 59 percent with dose-dense therapy against 48 percent with BEP (hazard ratio 0.66), with more haematological toxicity but no increase in toxic deaths; overall survival was not significantly different.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: The Lancet Oncology
- Year: 2014
- DOI: 10.1016/S1470-2045(14)70490-5
- Authors: Fizazi K, Pagliaro L, Laplanche A, et al.
- Findings: Three-year progression-free survival 59 percent vs 48 percent; hazard ratio 0.66.; Favourable marker decline identified men doing well on standard BEP (70 percent progression-free survival).
- What it means: Marker decline after the first BEP cycle is now assessed in poor-risk disease, and intensification is offered in expert centres to slow decliners.
- Caveats: No significant overall survival difference; toxicity of the intensified regimen requires specialist care.

## Sources

- Lancet Oncol 2014: https://doi.org/10.1016/S1470-2045(14)70490-5
- PubMed: https://pubmed.ncbi.nlm.nih.gov/25456363/

## Connected records

- cancers: [Non-seminomatous germ cell tumour](https://onco.cc/cancers/non-seminoma/)
- journals: [The Lancet Oncology](https://onco.cc/journals/lancet-oncology/)

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