(UroToday.com) During the Mini Oral session of the European Society for Medical Oncology (ESMO) Annual Congress focusing on non-prostate genitourinary cancers, Dr. Gillessen presented an analysis of the updated IGCCCG dataset assessing the prognostic effect of relapsed clinical stage I compared to de novo metastatic testicular cancer patients.
The majority of patients with germ cell tumors (60-70%) present with clinical stage I disease. Active surveillance is the preferred treatment approach in these men but 15 to 30% of men managed with this approach will have relapse. Whether outcomes differ between patients with metastatic relapse following surveillance of stage I disease and those with equivalent burdens of disease who presented with de novo metastatic disease is uncertain.
The authors used the IGCCCG Updated database to identify all patients with gonadal disseminated GCT who had complete information on initial tumor stage whether CSI or de novo metastatic. Notably, the IGCCCG Updated database includes more than 12,000 patients including more than 2400 with seminoma treated by 30 academic contributing institutions who received cisplatin and etoposide-based first line chemotherapy between 1990 and 2013.
Patients relapsing from initial CSI were compared to patients with de novo metastatic GCT in terms of survival outcomes including progression-free survival and overall survival at 5 years (5y-PFS and 5y-OS). The Kaplan-Meier method and Cox proportional hazard models were used.
The authors included 1014 patients with seminoma (S) [298 (29.4%) relapsing from CSI, 716 (70.6%) de novo] and 3103 patients with non-seminoma (NS) [626 (20.2%) relapsing from CSI, 2477 (79.8%) de novo].
Among those patients with non-seminoma, there was no difference in outcome between relapsing and de novo patients within the same IGCCCG group (HR=0.89; 95% CI: 0.70-1.12). However, due to differences in the proportion of patients with M1 presenting with poor risk disease, there were differences overall between the two cohorts with worse progression-free survival among those with de novo disease.
A similar phenomenon was seen with respect to overall survival
Among patients with seminoma, they authors found no statistically significant differences in PFS and OS between patients relapsing from CSI and de novo metastatic disease (5y-PFS 87.6% versus 88.5% and 5y-OS 93.2% versus 96.1%).
However, IGCCCG group was more favorable in non-seminoma patients relapsing from CSI: (good risk: 82.1% vs 51.4%) and equal in patients with seminoma (good risk: 96.3% vs 96.4%). In spite of this, 112 of 626 (18%) patients with non-seminoma and 11 of 298 (4%) patients with seminoma who initially presented with CSI disease relapsed with intermediate or poor IGCCCG group.
Dr. Gillessen concluded that there were no differences in either progression-free or overall survival at 5-years for patients relapsing from initial CSI as compared to de novo metastatic patients within the same IGCCCG prognostic group. However, a substantial proportion of CSI patients relapsed with intermediate or poor prognostic features with a need of intensified treatment. The study underlines the importance of improving active surveillance techniques and schedules to detect recurrence as early as possible in CSI patients and to avoid unnecessary toxicity.
Presented by: Prof. Dr. Med. Silke Gillessen, Medical and Scientific Director, L'Istituto Oncologico della Svizzera Italiana (IOSI), and Co-founder of the Advanced Prostate Cancer Consensus Conference (APCCC).Written by: Christopher J.D. Wallis, University of Toronto Twitter: @WallisCJD during the 2022 European Society of Medical Oncology (ESMO) Annual Hybrid Meeting, Paris, FR, Fri, Sept 9 – Tues, Sept 13, 2022.