Comparison of Two Standard Chemotherapy Regimens for Good-Prognosis Germ Cell Tumors: Updated Analysis of a Randomized Trial -- Grimison et al., 10.1093/jnci/djq245 -- JNCI Journal of the National Cancer Institute

Journal of the National Cancer Institute Advance Access published online on July 14, 2010
JNCI Journal of the National Cancer Institute, doi:10.1093/jnci/djq245
© The Author 2010. Published by Oxford University Press.

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Article

Comparison of Two Standard Chemotherapy Regimens for Good-Prognosis Germ Cell Tumors: Updated Analysis of a Randomized Trial
Peter S. Grimison, Martin R. Stockler, Damien B. Thomson, Ian N. Olver, Vernon J. Harvey, Val J. Gebski, Craig R. Lewis, John A. Levi, Michael J. Boyer, Howard Gurney, Paul Craft, Amy L. Boland, R. John Simes, Guy C. Toner

Affiliations of authors: NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia (PSG, VJG, ALB, RJS); Sydney Cancer Centre, RPA and Concord Hospitals, Sydney, Australia (MRS, MJB); Department of Medical Oncology, Princess Alexandra Hospital, Brisbane, Australia (DBT); Cancer Council Australia, Sydney, Australia (INO); Regional Cancer Service, Department of Medical Oncology, Auckland Hospital, Auckland, New Zealand (VJH); Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia (CRL); Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia (JAL); Department of Medical Oncology, Westmead Hospital, Sydney, Australia (HG); Department of Medical Oncology, Canberra Hospital, Canberra, Australia (PC); Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia (GCT)

Correspondence to: Peter Grimison, BSc(Med), MBBS(Hons), MPH, PhD, FRACP, Sydney Cancer Centre, Gloucester House 6, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia (e-mail: peter.grimison@ctc.usyd.edu.au).

Background: The Australian and New Zealand Germ Cell Trials Group conducted a multicenter randomized phase III trial in men with good-prognosis germ cell tumors of two standard chemotherapy regimens that contained bleomycin, etoposide, and cisplatin but differed in the scheduling and total dose of cisplatin, the total dose of bleomycin, and the scheduling and dose intensity of etoposide. The trial was stopped early at a median follow-up of 33 months after a planned interim analysis found a survival benefit for the more dose-intense regimen. The aim of this analysis was to determine if this survival benefit was maintained with long-term follow-up.

Methods: Between February 1994 and April 2000, 166 men with good-prognosis metastatic germ cell tumors defined by modified Memorial Sloan-Kettering criteria were randomly assigned to receive 3B90E500P (three cycles, repeated every 21 days, of 30 kU bleomycin on days 1, 8, and 15; 100 mg/m2 etoposide on days 1–5; and 20 mg/m2 cisplatin on days 1–5; n = 83) or 4B30E360P (four cycles, repeated every 21 days, of 30 kU bleomycin on day 1, 120 mg/m2 etoposide on days 1–3, and 100 mg/m2 cisplatin on day 1; n = 83). Endpoints included overall survival, progression-free survival, and quality of life and side effects, which were assessed using the Spitzer Quality of Life Index and the GLQ-8, respectively, before random assignment and during and after treatment. All analyses were by intention to treat. All P values are two-sided.

Results: The median follow-up was 8.5 years. All but five survivors (3%) were followed up for at least 5 years. Overall survival remained better in those assigned to 3B90E500P than in those assigned to 4B30E360P (8-year survival: 92% vs 83%; hazard ratio of death = 0.38, 95% confidence interval = 0.15 to 0.97, P = .037). Progression-free survival favored 3B90E500P but was not statistically significantly different between the treatment groups (8-year progression-free survival, 3B90E500P vs 4B30E360P: 86% vs 79%; hazard ratio of progression = 0.6, 95% confidence interval = 0.3 to 1.1, P = .15). At the end of treatment, average scores for most side effect scales favored 3B90E500P. After the completion of treatment, average GLQ-8 scores for numbness (P = .003) and hair loss (P = .04) and the Spitzer Quality of Life Index (P = .05) favored 3B90E500P.

Conclusion: The survival benefit of 3B90E500P over 4B30E360P was maintained with long-term follow-up.

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Comparison of Two Standard Chemotherapy Regimens for Good-Prognosis Germ Cell Tumors: Updated Analysis of a Randomized Trial -- Grimison et al., 10.1093/jnci/djq245 -- JNCI Journal of the National Cancer Institute