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

Abstract

Background

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).

Method

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.

Results

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).

Conclusion

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.