While most men with stage I non-seminoma who have adjuvant BEP will not relapse, very little is known about the small minority of men who do, in fact, relapse after adjuvant BEP. Dr. Stefanie Christine Fischer presented a retrospective data analysis of 51 patients from 18 separate academic medical centers who had a relapse of stage I non-seminoma after adjuvant BEP. Their primary objectives were overall survival (OS) and progression-free survival (PFS). Secondary objectives included time to relapse, stage at relapse, treatment of relapse, and subsequent relapses. Median follow-up for their cohort was 96 months.
Fischer and colleagues found that the median time to relapse after adjuvant BEP was 13 months for all patients, however, patients who relapsed with teratoma only had a median relapse of 9 months, versus 19 months for patients who relapsed with non-teratoma. Relapse was most commonly detected by routine follow-up imaging in 88% of the men studied. Clinical stage at relapsed varied, with 14% of patients being IIA, 30% IIB, 14% IIC, and 33% stage III. 85% of patients were IGCCCG good prognosis. Importantly, 83% of the patients had embryonal carcinoma as their initial histology.
They next evaluated the heterogeneity of treatments offered at the time of relapse. 29% of patients underwent surgery alone, 2% underwent surgery and radiotherapy, while 24% received chemotherapy alone, and 45% of patients received combination surgery and chemotherapy. The chemotherapy regimens offered to these patients varied significantly between centers, suggesting the lack of data that exists to guide the optimal treatment for relapse in this group of patients. Fischer next showed that the risk of subsequent relapse was found in 29% of patients, with 29% of those relapses occurring > 3 years from initial treatment. At the last follow-up for the study, 80% of men were alive and disease-free, while 16% died due to disease progression.
Dr. Fischer concluded that this cohort of patients tends to have worse outcomes than in patients with chemo-naïve metastatic disease, but still better outcomes than relapsed metastatic disease. She believes the substantial rate of late and subsequent relapses in this cohort of patients indicates more aggressive cancer biology. She highlighted the fact that improved knowledge about outcomes in these patients could help determine the frequency and duration of follow-up in higher risk patients. She notes that further research is needed to determine what is the optimal therapy for relapsed patients.
Presented by: Stephanie Christine Fischer, MD, Division of Cancer Sciences, University of Manchester, and the Christie Manchester, Manchester, United Kingdom
Written by: Brian Kadow, MD, Society of Urologic Oncology Fellow, Fox Chase Cancer Center at the 2019 American Society of Clinical Oncology Genitourinary Cancers Symposium, (ASCO GU) #GU19, February 14-16, 2019 - San Francisco, CA