Emergency Etoposide-Cisplatin (Em-EP) for patients with germ cell tumours (GCT) and trophoblastic neoplasia (TN)


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Charleen Chan Wah Hak1,Christopher Coyle1,Arwa Kocache1,Delia Short1,Naveed Sarwar1,Michael Seckl1,Michael Gonzalez1
1Charing Cross Hospital, Imperial College Healthcare NHS Trust, London



Etoposide (E) at 100 mg/m2 combined with Cisplatin (P) at 20 mg/m2 is an induction 2-day regimen embedded in our clinical practice for patients with both advanced GCT and TN at high risk of early death. We evaluated 24/7 Em-EP administration to this combined cohort at our Emergency Cancer Treatment Centre (ECTC).


Patients who received Em-EP between 1st January 2012 and 31st December 2016 were identified from electronic databases at Imperial College Healthcare NHS Trust. Data collected included patient demographics, treatment details and clinical outcome.


Em-EP chemotherapy was administered in the emergency setting to 104 patients, predominantly young adults (median age 35, range 17-71).  Half the cases (n=52) were GCT: 22 male (6 seminomas, 16 non-seminomas); 30 female (2 dysgerminomas, 28 non-dysgerminomas). The other 50% (n=52) were treated for TN: 48 gestational (GTN) and 4 non-gestational. Primary disease sites included: uterine (n=44, 42%), gonadal (n=41, 39%), extragonadal (n=10, 10%) and unknown (n=9, 9%). Most patients received Em-EP for a new cancer diagnosis (n=100, 96%), within 24 hours (n=93, 89%) and out-of-hours (n=74, 70%). 66 patients (63%) were symptomatic, 51 (49%) had high-burden disease and 9 (9%) required Intensive Care Unit admission. The prevalence of neutropaenic sepsis was 5%. 102 patients (98%) remained alive at 4 weeks after their first Em-EP administration. At follow-up (median 9 months, range 0-64 months), overall survival for patients who received Em-EP was 81%, higher in TN (92%) than for GCTs (69%; OR 0.19, p=0.0053, 95% CI 0.06-0.61).


Em-EP represents a standard approach at our ECTC for the initial management of high-risk patients with both GCT and TN. Despite the potentially fatal complications encountered in the acute setting, early mortality with Em-EP is low. Its efficacy within a prospective cohort and in other platinum-sensitive malignancies requires further evaluation.