Although metastatic germ cell tumor (GCT) is highly curable with initial cisplatin-based chemotherapy (CT), 20-30% of patients relapse. Salvage CT options include conventional (CDCT) and high dose chemotherapy (HDCT), however definitive comparative data remain lacking. We aimed to characterize the contemporary practice patterns of salvage CT across Canada.
We conducted a 30-question online survey for Canadian medical and hematological oncologists with experience in treating GCT, assessing treatment availability, patient selection, and management strategies used for relapsed GCT patients.
There were 30 respondents from 18 cancer centers across eight provinces. The most common CDCT regimens used were TIP (64%) and VIP (25%). HDCT was available in 13 centers (70%). The HDCT regimen used included carboplatin and etoposide for two cycles (76% in 7 centers), three cycles (6% in 2 centers), and the TICE protocol (11%, in 2 centers). "Bridging" CDCT was used by 65% of respondents. Post-HDCT treatments considered include surgical resection for residual disease (87.5%), maintenance etoposide (6.3%), and surveillance only (6.3%).
HDCT is the most commonly used GCT salvage strategy in Canada. Significant differences exist in the treatment availability, selection, and delivery of HDCT, highlighting the need for standardization of care for patients with relapsed testicular GCT.
Current oncology (Toronto, Ont.). 2023 Jun 27*** epublish ***
Esmail M Al-Ezzi, Amer Zahralliyali, Aaron R Hansen, Robert J Hamilton, Michael Crump, John Kuruvilla, Lori Wood, Lucia Nappi, Christian K Kollmannsberger, Scott A North, Eric Winquist, Denis Soulières, Sebastien J Hotte, Di Maria Jiang
Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5S 1A1, Canada., Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5S 1A1, Canada., Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS B3H 4R2, Canada., Department of Medicine, British Columbia Cancer Agency, University of British Columbia, Vancouver, BC V6T 1Z1, Canada., Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB T6G 2R3, Canada., Department of Oncology, London Health Sciences Centre, Western University, London, ON N6A 3K7, Canada., Département Hématologie-Oncologie, Centre Hospitalier de l'Université de Montréal, Montréal, QC H2X 0C1, Canada., Juravinski Cancer Centre, McMaster University, Hamilton, ON L8S 4L8, Canada.