Paclitaxel, Iphospamide, and Cisplatin (TIP) as Bleomycin, Etoposide, and Cisplatin (BEP) Alternative for First-Line Therapy of Metastatic Germ Cell Tumor (GCT): A Case Series
DOI : 10.33371/ijoc.v13i3.659
Background: Bleomycin, etoposide, and cisplatin (BEP) is a standard first-line therapy for metastatic germ cell tumor (GCT), while paclitaxel, ifosfamide, and cisplatin (TIP) are commonly used as salvage therapy after failed BEP treatment. The unavailability of first-line drugs can be the reason for the use of second-line therapy. In this paper, we reviewed two initial cases of patients with metastatic GCT treated with TIP as first-line chemotherapy in our center.
Case Presentation: We reviewed the medical record and followed up two patients who had been treated with TIP as first-line chemotherapy for metastatic GCT due to lack of BEP regiment. We evaluated efficacy and toxicity of this treatment. These two patients were diagnosed with seminoma, with intermediate-risk according to International Germ Cell Cancer Collaborative Group (IGCCCG) classification. Both achieved complete response after four courses of TIP chemotherapy with toxicities mainly consisted of myelosuppression.
Conclusions: TIP demonstrated efficacy serves as the first-line therapy for germ cell tumors with an acceptable safety profile. Further studies with larger subjects are still needed for evaluation. However, TIP is more expensive compared to BEP, making BEP is still superior to TIP in public hospital setting where cost-effectiveness of treatment is important.
- Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74-108.
- Ferlay J, Bray F, Pisani P. GLOBOCAN 2000: cancer incidence, mortality, and prevalence worldwide. IARC Cancer Base No, 5. Lyon: IARC: 2001.
- Schmoll HJ, Souchon R, Krege S, Albers P, Beyer J, Kollmannsberger C, et al. European consensus on diagnosis and treatment of germ cell cancer: a report of the European Germ Cell Cancer Consensus Group (EGCCCG). Ann Oncol. 2004;15:1377-99.
- Shanmugalingam T, Soultati A, Chowdhury S, Van Hemelrijck M. Global incidence and outcome of testicular cancer. Clin Epidemiol. 2013;5:417-427.
- Bray F, Richiardi L, Ekborn A, Pukkala E, Cuninkova M, Moller H. Trends in testicular cancer incidence and mortality in 22 European countries: continuing increases in incidence and declines in mortality. Int J Cancer. 2006;118(12):3099-111.
- Ehrlich Y, Margel D, Lubin MA, Baniel J, Advances in the treatment of testicular cancer. Transl Androl Urol. 2015;4(3):381-90.
- Einhorn LH and Donohue JP: Advanced testicular cancer: update for urologists. J Urol. 1998:160: 1964-9.
- International Germ Cell Cancer Collaborative Group: International Germ Cell Consensus Classiﬁcation: A prognostic factor-based staging system for metastatic germ cell cancers — International Germ Cell Cancer Collaborative Group. J Clin Oncol.1997;15:594-603.
- Motzer RJ, Sheinfeld J, Mazumdar M, Bains M, Mariani T, Bajic J, et al. Paclitaxel, ifosfamide, and cisplatin second-line therapy for patients with relapsed testicular germ cell cancer. J Clin Oncol. 2000:18;2413–8.
- Gilligan T, Beard C, Carneiro B, Chism D, Cost N, Derweesh IH, et al. NCCN Guidelines Version 2, 2018. Testicular Cancer.
- Feldman DR, Hu J, Dorff TB, Lim K, Patil S, Woo KM, et al. Paclitaxel, ifosfamide, and cisplatin efficacy for first-line treatment of patients with intermediate or poor-risk germ cell tumors. J Clin Oncol.2016;34:2478-83.
- National Cancer Institute. Common Terminology Criteria for Adverse Events v4.0. http://ctep.cancer.gov/protocolDevelopment/electronicapplications/ctc.htm
- Kondagunta GV, Bacik J, Sheinfeld J, Bajorin D, Bains M, Reich L et al. Paclitaxel plus ifosfamide followed by high-dose carboplatin plus etoposide in previously treated germ cell tumors. J Clin Oncol. 2007:25;85–90.
- Nakamura T, Miki T. Recent strategy for the management of advanced testicular cancer. Int J Urol. 2010:17;148-57.
- Kurobe M, Kawai K, Oikawa T, Ichioka D, Kandori S, Takaoka E. et al. Paclitaxel, ifosfamide, and cisplatin (TIP) as salvage therapy and consolidation chemotherapy for advanced germ cell tumor. J Cancer Res Clin Oncol. 2015;141:127–33.
- Mead GM, Cullen MH, Huddart R, Harper P, Rustin GSJ, Cook PA, et al. A phase II trial of TIP given as second line (post –BEP) salvage chemotheraphy for patients with metastatic germ cell cancer; a medical research council trial. Br J Cancer. 2005;93:178-84.
- Feldman DR, Bosl GJ, Sheinfeld J, Motzer RZ. Medical treatment of advanced testicular cancer. JAMA. 2008:299:672-84.
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