GETUG 13: personalised chemotherapy based on tumour marker decline in poor-prognosis germ cell tumours
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.
Overview
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.
- 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).
Marker decline after the first BEP cycle is now assessed in poor-risk disease, and intensification is offered in expert centres to slow decliners.
- No significant overall survival difference; toxicity of the intensified regimen requires specialist care.