Scalp Cooling in Preventing Persistent Chemotherapy-Induced Alopecia: A Randomized Controlled Trial
I guess scalp cooling does have some objective evidence that it works. Still the expense and time constraints will need to be considered.
Paclitaxel, Ifosfamide, and Cisplatin as Initial Salvage Chemotherapy for Germ Cell Tumors: Long-Term Follow-Up and Outcomes for Favorable- and Unfavorable-Risk Disease
Author(s): Jack P. Gleeson, MB BCh BAO, MRCPI1,2; Andrea Knezevic, MS3; Maria Bromberg, MPH4; Sujata Patil, MD3; Brett S. Carver, MD5,6; Manjit Bains, MD5,6; David R. Jones, MD5,6; Joel Sheinfeld, MD5,6; Dean F. Bajorin, MD4,6; George J. Bosl, MD4,6; Deaglan J. McHugh, MD4,6; Samuel A. Funt, MD4,6; Robert J. Motzer, MD4,6; Darren R. Feldman, MD4,6
Source: https://doi.org/10.1200/JCO.23.0254
Dr. Anjan Patel's Thoughts
TIP will likely become the established salvage therapy for GCT’s if this study’s findings are confirmed in the ongoing Phase III TIGER trial.
PURPOSE
Paclitaxel, ifosfamide, and cisplatin (TIP) is an established salvage regimen for germ cell tumors (GCT) on the basis of a phase II trial, but efficacy on a large patient cohort including patients with unfavorable risk features and long-term outcomes has not been reported. Herein, we report updated treatment efficacy and long-term follow-up with TIP.
PATIENTS AND METHODS
Patients with GCT who received TIP after cisplatin-based chemotherapy were eligible. Favorable response (complete response or partial response with negative tumor markers), overall survival (OS) and progression-free survival (PFS) rates, relapse, and toxicity were determined. Disease was reclassified according to the International Prognostic Factor Study Group (IPFSG) score.
RESULTS
Of the 104 patients, 87 had favorable risk factors and 17 had at least one unfavorable factor by Memorial Sloan Kettering Cancer Center (MSKCC) criteria. Ten patients were treated for a second gonadal primary GCT. With a median follow-up of 8.9 years, the 5-year PFS and OS rates were 66% (95% CI, 55 to 74) and 69% (95% CI, 59 to 77), respectively. Among 87 patients with favorable-risk disease, 69 (79%) achieved a favorable response with 5-year PFS and OS rates of 67% (95% CI, 56 to 76) and 72% (95% CI, 61 to 80), respectively. Among 17 patients with MSKCC unfavorable-risk disease, 13 (76%) achieved a favorable response with 5-year PFS and OS rates of 59% (95% CI, 33 to 78) and 56% (95% CI, 28 to 76), respectively. After IPFSG reclassification, 5-year PFS and OS rates for patients with ≤intermediate-risk disease were 75% (95% CI, 50 to 89) and 73% (95% CI, 55 to 85), respectively.
CONCLUSION
TIP is an effective second-line regimen for patients with GCT. Similar outcomes were observed in patients with favorable- and unfavorable-risk disease. The randomized TIGER trial (ClinicalTrials.gov identifier: NCT02375204) comparing TIP with high-dose chemotherapy will determine the optimal second-line treatment approach.
Author Affiliations
1Cancer Research @UCC, College of Medicine and Health, University College Cork, Cork, Ireland; 2Medical Oncology Department, Cork University Hospital, Cork, Ireland; 3Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY; 4Genitourinary Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; 5Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY; 6Weill Cornell Medical College, New York, NYRelated Articles
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