Germ Cell Cancer and Multiple Relapses

Toxicity and Survival

Jakob Lauritsen, Maria G G Kier, Mette S Mortensen, Mikkel Bandak, Ramneek Gupta, Niels V Holm, Mads Agerbaek, Gedske Daugaard

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

PURPOSE: A small number of patients with germ cell cancer (GCC) receive more than one line of treatment for disseminated disease. The purpose of this study was to evaluate late toxicity and survival in an unselected cohort of patients who experienced relapse after receiving first-line treatment for disseminated disease.

METHODS: From the Danish Testicular Cancer database, we identified all patients who received more than one line of treatment for disseminated disease. Information about late toxicity and mortality was obtained by means of linkage to national registers. Prognostic factors for relapse and death were identified and compared with the International Prognostic Factors Study Group (IPFSG) classification.

RESULTS: In total, 268 patients received more than one line of treatment for disseminated GCC. Approximately half of patients (n = 136) died as a result of GCC. The 132 remaining patients, compared with patients treated with only orchiectomy, had an increased risk for a second cancer (hazard ratio [HR], 3.2; 95% CI, 1.9 to 5.5), major cardiovascular disease (HR, 1.9; 95% CI, 1.0 to 3.3), pulmonary disease (HR, 2.0; 95% CI, 1.0 to 3.8), GI disease (HR, 7.3; 95% CI, 3.6 to 14.8), renal impairment (HR, 8.3; 95% CI, 3.0 to 23.2), neurologic disorders (HR, 6.3; 95% CI, 3.1 to 12.6), and death as a result of other causes (HR, 2.6; 95% CI, 1.6 to 4.2). In large part, the IPFSG classification was confirmed in our population; however, we could not confirm the primary site and the level of human chorionic gonadotropin as independent factors. We identified increasing age as a possible new prognostic factor for treatment failure after second-line treatment (HR, 1.2 per 10 years; 95% CI, 1.2 to 15).

CONCLUSION: Patients with GCC who survive after more than one line of treatment for disseminated disease have a highly increased risk of late toxicity and death as a result of causes other than GCC. Therefore, they should be candidates for life-long follow-up. The IPFSG classification was confirmed in this unselected population.

Original languageEnglish
JournalJournal of Clinical Oncology
Volume33
Issue number28
Pages (from-to) 3116-3123
ISSN0732-183X
DOIs
Publication statusPublished - 2015

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Germ Cell and Embryonal Neoplasms
Orchiectomy
Second Primary Neoplasms
Chorionic Gonadotropin
Nervous System Diseases
Treatment Failure
Population
Lung Diseases
Databases
Kidney

Cite this

Lauritsen, J., Kier, M. G. G., Mortensen, M. S., Bandak, M., Gupta, R., Holm, N. V., ... Daugaard, G. (2015). Germ Cell Cancer and Multiple Relapses: Toxicity and Survival. Journal of Clinical Oncology, 33(28), 3116-3123. https://doi.org/10.1200/JCO.2014.60.1310
Lauritsen, Jakob ; Kier, Maria G G ; Mortensen, Mette S ; Bandak, Mikkel ; Gupta, Ramneek ; Holm, Niels V ; Agerbaek, Mads ; Daugaard, Gedske. / Germ Cell Cancer and Multiple Relapses : Toxicity and Survival. In: Journal of Clinical Oncology. 2015 ; Vol. 33, No. 28. pp. 3116-3123.
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title = "Germ Cell Cancer and Multiple Relapses: Toxicity and Survival",
abstract = "PURPOSE: A small number of patients with germ cell cancer (GCC) receive more than one line of treatment for disseminated disease. The purpose of this study was to evaluate late toxicity and survival in an unselected cohort of patients who experienced relapse after receiving first-line treatment for disseminated disease.METHODS: From the Danish Testicular Cancer database, we identified all patients who received more than one line of treatment for disseminated disease. Information about late toxicity and mortality was obtained by means of linkage to national registers. Prognostic factors for relapse and death were identified and compared with the International Prognostic Factors Study Group (IPFSG) classification.RESULTS: In total, 268 patients received more than one line of treatment for disseminated GCC. Approximately half of patients (n = 136) died as a result of GCC. The 132 remaining patients, compared with patients treated with only orchiectomy, had an increased risk for a second cancer (hazard ratio [HR], 3.2; 95{\%} CI, 1.9 to 5.5), major cardiovascular disease (HR, 1.9; 95{\%} CI, 1.0 to 3.3), pulmonary disease (HR, 2.0; 95{\%} CI, 1.0 to 3.8), GI disease (HR, 7.3; 95{\%} CI, 3.6 to 14.8), renal impairment (HR, 8.3; 95{\%} CI, 3.0 to 23.2), neurologic disorders (HR, 6.3; 95{\%} CI, 3.1 to 12.6), and death as a result of other causes (HR, 2.6; 95{\%} CI, 1.6 to 4.2). In large part, the IPFSG classification was confirmed in our population; however, we could not confirm the primary site and the level of human chorionic gonadotropin as independent factors. We identified increasing age as a possible new prognostic factor for treatment failure after second-line treatment (HR, 1.2 per 10 years; 95{\%} CI, 1.2 to 15).CONCLUSION: Patients with GCC who survive after more than one line of treatment for disseminated disease have a highly increased risk of late toxicity and death as a result of causes other than GCC. Therefore, they should be candidates for life-long follow-up. The IPFSG classification was confirmed in this unselected population.",
author = "Jakob Lauritsen and Kier, {Maria G G} and Mortensen, {Mette S} and Mikkel Bandak and Ramneek Gupta and Holm, {Niels V} and Mads Agerbaek and Gedske Daugaard",
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Lauritsen, J, Kier, MGG, Mortensen, MS, Bandak, M, Gupta, R, Holm, NV, Agerbaek, M & Daugaard, G 2015, 'Germ Cell Cancer and Multiple Relapses: Toxicity and Survival', Journal of Clinical Oncology, vol. 33, no. 28, pp. 3116-3123. https://doi.org/10.1200/JCO.2014.60.1310

Germ Cell Cancer and Multiple Relapses : Toxicity and Survival. / Lauritsen, Jakob; Kier, Maria G G; Mortensen, Mette S; Bandak, Mikkel; Gupta, Ramneek; Holm, Niels V; Agerbaek, Mads; Daugaard, Gedske.

In: Journal of Clinical Oncology, Vol. 33, No. 28, 2015, p. 3116-3123.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Germ Cell Cancer and Multiple Relapses

T2 - Toxicity and Survival

AU - Lauritsen, Jakob

AU - Kier, Maria G G

AU - Mortensen, Mette S

AU - Bandak, Mikkel

AU - Gupta, Ramneek

AU - Holm, Niels V

AU - Agerbaek, Mads

AU - Daugaard, Gedske

N1 - © 2015 by American Society of Clinical Oncology.

PY - 2015

Y1 - 2015

N2 - PURPOSE: A small number of patients with germ cell cancer (GCC) receive more than one line of treatment for disseminated disease. The purpose of this study was to evaluate late toxicity and survival in an unselected cohort of patients who experienced relapse after receiving first-line treatment for disseminated disease.METHODS: From the Danish Testicular Cancer database, we identified all patients who received more than one line of treatment for disseminated disease. Information about late toxicity and mortality was obtained by means of linkage to national registers. Prognostic factors for relapse and death were identified and compared with the International Prognostic Factors Study Group (IPFSG) classification.RESULTS: In total, 268 patients received more than one line of treatment for disseminated GCC. Approximately half of patients (n = 136) died as a result of GCC. The 132 remaining patients, compared with patients treated with only orchiectomy, had an increased risk for a second cancer (hazard ratio [HR], 3.2; 95% CI, 1.9 to 5.5), major cardiovascular disease (HR, 1.9; 95% CI, 1.0 to 3.3), pulmonary disease (HR, 2.0; 95% CI, 1.0 to 3.8), GI disease (HR, 7.3; 95% CI, 3.6 to 14.8), renal impairment (HR, 8.3; 95% CI, 3.0 to 23.2), neurologic disorders (HR, 6.3; 95% CI, 3.1 to 12.6), and death as a result of other causes (HR, 2.6; 95% CI, 1.6 to 4.2). In large part, the IPFSG classification was confirmed in our population; however, we could not confirm the primary site and the level of human chorionic gonadotropin as independent factors. We identified increasing age as a possible new prognostic factor for treatment failure after second-line treatment (HR, 1.2 per 10 years; 95% CI, 1.2 to 15).CONCLUSION: Patients with GCC who survive after more than one line of treatment for disseminated disease have a highly increased risk of late toxicity and death as a result of causes other than GCC. Therefore, they should be candidates for life-long follow-up. The IPFSG classification was confirmed in this unselected population.

AB - PURPOSE: A small number of patients with germ cell cancer (GCC) receive more than one line of treatment for disseminated disease. The purpose of this study was to evaluate late toxicity and survival in an unselected cohort of patients who experienced relapse after receiving first-line treatment for disseminated disease.METHODS: From the Danish Testicular Cancer database, we identified all patients who received more than one line of treatment for disseminated disease. Information about late toxicity and mortality was obtained by means of linkage to national registers. Prognostic factors for relapse and death were identified and compared with the International Prognostic Factors Study Group (IPFSG) classification.RESULTS: In total, 268 patients received more than one line of treatment for disseminated GCC. Approximately half of patients (n = 136) died as a result of GCC. The 132 remaining patients, compared with patients treated with only orchiectomy, had an increased risk for a second cancer (hazard ratio [HR], 3.2; 95% CI, 1.9 to 5.5), major cardiovascular disease (HR, 1.9; 95% CI, 1.0 to 3.3), pulmonary disease (HR, 2.0; 95% CI, 1.0 to 3.8), GI disease (HR, 7.3; 95% CI, 3.6 to 14.8), renal impairment (HR, 8.3; 95% CI, 3.0 to 23.2), neurologic disorders (HR, 6.3; 95% CI, 3.1 to 12.6), and death as a result of other causes (HR, 2.6; 95% CI, 1.6 to 4.2). In large part, the IPFSG classification was confirmed in our population; however, we could not confirm the primary site and the level of human chorionic gonadotropin as independent factors. We identified increasing age as a possible new prognostic factor for treatment failure after second-line treatment (HR, 1.2 per 10 years; 95% CI, 1.2 to 15).CONCLUSION: Patients with GCC who survive after more than one line of treatment for disseminated disease have a highly increased risk of late toxicity and death as a result of causes other than GCC. Therefore, they should be candidates for life-long follow-up. The IPFSG classification was confirmed in this unselected population.

U2 - 10.1200/JCO.2014.60.1310

DO - 10.1200/JCO.2014.60.1310

M3 - Journal article

VL - 33

SP - 3116

EP - 3123

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 28

ER -