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

Source: https://onco.cc/key-papers/paper-getug-13-marker-guided-dose-dense-chemotherapy-fizazi-lancet-oncol-2014/  
OnCo record `paper-getug-13-marker-guided-dose-dense-chemotherapy-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

Men with poor-prognosis testicular cancer whose tumour markers fell too slowly after one cycle of BEP did better when their chemotherapy was intensified, with fewer needing high-dose salvage treatment.

## Summary

Phase 3 multicentre randomised trial: of 263 patients with poor-prognosis non-seminomatous germ cell tumours, 203 with an unfavourable marker decline after one BEP cycle were randomised to continue BEP (98) or switch to dose-dense chemotherapy (105); 51 with a favourable decline continued BEP.

Three-year progression-free survival was 59 percent with dose-dense chemotherapy against 48 percent with BEP (hazard ratio 0.66, p 0.05) and 70 percent in the favourable group. More grade 3 to 4 neurotoxicity and haematotoxicity occurred with intensification, with no difference in toxic deaths; salvage high-dose chemotherapy was needed in 6 against 16 percent.

## Fields

- Kind: Key paper
- Last checked: 2026-09-22
- 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 (95% CI 49 to 68) versus 48 percent (38 to 59); hazard ratio 0.66 (0.44 to 1.00), p 0.05.; Favourable marker decline group: three-year progression-free survival 70 percent (57 to 81).; Salvage high-dose chemotherapy 6 versus 16 percent; grade 3 to 4 neurotoxicity 7 versus 1 percent.
- What it means: Early tumour marker decline should guide treatment intensification in poor-prognosis germ cell tumours, which is now standard in expert centres.
- Caveats: Borderline statistical significance; the dose-dense regimen is complex and toxic and belongs in high-volume centres.

## 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/), [Testicular germ cell tumours](https://onco.cc/cancers/testicular/)
- trials: [GETUG 13](https://onco.cc/trials/getug-13/)
- journals: [The Lancet Oncology](https://onco.cc/journals/lancet-oncology/)

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