Patterns of relapse in poor-prognosis germ-cell tumours in the GETUG 13 trial: Implications for assessment of brain metastases

Y. Loriot, L. Pagliaro, A. Fléchon, J. Mardiak, L. Geoffrois, P. Kerbrat, C. Chevreau, R. Delva, F. Rolland, C. Theodore, G. Roubaud, G. Gravis, J. C. Eymard, J. P. Malhaire, C. Linassier, M. Habibian, A. L. Martin, F. Journeau, M. Reckova, C. LogothetisA. Laplanche, G. Le Teuff, S. Culine, K. Fizazi

Research output: Contribution to journalArticle

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Abstract

Background The GETUG 13 phase III trial tested personalised chemotherapy based on tumour marker decline in patients with poor-prognosis germ-cell tumour (GCT) and demonstrated that a dose-dense regimen improves progression-free survival in patients with an unfavourable decline. We investigated the pattern of relapse for patients included in GETUG 13. Methods We conducted an analysis of relapse events in patients from GETUG 13. Baseline procedures before inclusion in the trial comprised a thoraco-abdomino-pelvic computed tomography scan and a magnetic resonance imaging of the brain. Results With a median follow-up of 4.1 years (0.3; 8.8 years), a progression event was observed in 109/254 patients (43%). First event consisted in a marker progression only in 47 patients (43%), a radiographic progression only in 35 patients (32%), a mix progression on both markers and imaging in 12 patients (11%) and death in 15 patients (14%). In patients with radiographic progression only, brain was the predominant site (n = 19/35, 54%). Among patients with unfavourable decline who experienced a radiographic progression (as first and subsequent progression event, n = 58), brain was a site of progression in 28 patients (48%): 12/30 (40%) in patients treated with cisplatin, bleomycin and etoposide and 16/28 (57%) in those treated with dose-dense chemotherapy. Conclusions Brain metastases develop often, early and frequently as the only site of relapse in the course of poor-prognosis GCT. This raises the question of early detection and optimal treatment of brain metastases in these patients, e.g. by integrating a systematic brain MRI after 2–3 months of chemotherapy.

Original languageEnglish (US)
Pages (from-to)140-146
Number of pages7
JournalEuropean Journal of Cancer
Volume87
DOIs
StatePublished - Dec 1 2017

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Germ Cell and Embryonal Neoplasms
Neoplasm Metastasis
Recurrence
Brain
Drug Therapy
Bleomycin
Etoposide
Tumor Biomarkers
Cisplatin
Disease-Free Survival

Keywords

  • Brain metastase
  • Germ-cell cancer

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Patterns of relapse in poor-prognosis germ-cell tumours in the GETUG 13 trial : Implications for assessment of brain metastases. / Loriot, Y.; Pagliaro, L.; Fléchon, A.; Mardiak, J.; Geoffrois, L.; Kerbrat, P.; Chevreau, C.; Delva, R.; Rolland, F.; Theodore, C.; Roubaud, G.; Gravis, G.; Eymard, J. C.; Malhaire, J. P.; Linassier, C.; Habibian, M.; Martin, A. L.; Journeau, F.; Reckova, M.; Logothetis, C.; Laplanche, A.; Le Teuff, G.; Culine, S.; Fizazi, K.

In: European Journal of Cancer, Vol. 87, 01.12.2017, p. 140-146.

Research output: Contribution to journalArticle

Loriot, Y, Pagliaro, L, Fléchon, A, Mardiak, J, Geoffrois, L, Kerbrat, P, Chevreau, C, Delva, R, Rolland, F, Theodore, C, Roubaud, G, Gravis, G, Eymard, JC, Malhaire, JP, Linassier, C, Habibian, M, Martin, AL, Journeau, F, Reckova, M, Logothetis, C, Laplanche, A, Le Teuff, G, Culine, S & Fizazi, K 2017, 'Patterns of relapse in poor-prognosis germ-cell tumours in the GETUG 13 trial: Implications for assessment of brain metastases', European Journal of Cancer, vol. 87, pp. 140-146. https://doi.org/10.1016/j.ejca.2017.09.029
Loriot, Y. ; Pagliaro, L. ; Fléchon, A. ; Mardiak, J. ; Geoffrois, L. ; Kerbrat, P. ; Chevreau, C. ; Delva, R. ; Rolland, F. ; Theodore, C. ; Roubaud, G. ; Gravis, G. ; Eymard, J. C. ; Malhaire, J. P. ; Linassier, C. ; Habibian, M. ; Martin, A. L. ; Journeau, F. ; Reckova, M. ; Logothetis, C. ; Laplanche, A. ; Le Teuff, G. ; Culine, S. ; Fizazi, K. / Patterns of relapse in poor-prognosis germ-cell tumours in the GETUG 13 trial : Implications for assessment of brain metastases. In: European Journal of Cancer. 2017 ; Vol. 87. pp. 140-146.
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abstract = "Background The GETUG 13 phase III trial tested personalised chemotherapy based on tumour marker decline in patients with poor-prognosis germ-cell tumour (GCT) and demonstrated that a dose-dense regimen improves progression-free survival in patients with an unfavourable decline. We investigated the pattern of relapse for patients included in GETUG 13. Methods We conducted an analysis of relapse events in patients from GETUG 13. Baseline procedures before inclusion in the trial comprised a thoraco-abdomino-pelvic computed tomography scan and a magnetic resonance imaging of the brain. Results With a median follow-up of 4.1 years (0.3; 8.8 years), a progression event was observed in 109/254 patients (43{\%}). First event consisted in a marker progression only in 47 patients (43{\%}), a radiographic progression only in 35 patients (32{\%}), a mix progression on both markers and imaging in 12 patients (11{\%}) and death in 15 patients (14{\%}). In patients with radiographic progression only, brain was the predominant site (n = 19/35, 54{\%}). Among patients with unfavourable decline who experienced a radiographic progression (as first and subsequent progression event, n = 58), brain was a site of progression in 28 patients (48{\%}): 12/30 (40{\%}) in patients treated with cisplatin, bleomycin and etoposide and 16/28 (57{\%}) in those treated with dose-dense chemotherapy. Conclusions Brain metastases develop often, early and frequently as the only site of relapse in the course of poor-prognosis GCT. This raises the question of early detection and optimal treatment of brain metastases in these patients, e.g. by integrating a systematic brain MRI after 2–3 months of chemotherapy.",
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T1 - Patterns of relapse in poor-prognosis germ-cell tumours in the GETUG 13 trial

T2 - Implications for assessment of brain metastases

AU - Loriot, Y.

AU - Pagliaro, L.

AU - Fléchon, A.

AU - Mardiak, J.

AU - Geoffrois, L.

AU - Kerbrat, P.

AU - Chevreau, C.

AU - Delva, R.

AU - Rolland, F.

AU - Theodore, C.

AU - Roubaud, G.

AU - Gravis, G.

AU - Eymard, J. C.

AU - Malhaire, J. P.

AU - Linassier, C.

AU - Habibian, M.

AU - Martin, A. L.

AU - Journeau, F.

AU - Reckova, M.

AU - Logothetis, C.

AU - Laplanche, A.

AU - Le Teuff, G.

AU - Culine, S.

AU - Fizazi, K.

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Background The GETUG 13 phase III trial tested personalised chemotherapy based on tumour marker decline in patients with poor-prognosis germ-cell tumour (GCT) and demonstrated that a dose-dense regimen improves progression-free survival in patients with an unfavourable decline. We investigated the pattern of relapse for patients included in GETUG 13. Methods We conducted an analysis of relapse events in patients from GETUG 13. Baseline procedures before inclusion in the trial comprised a thoraco-abdomino-pelvic computed tomography scan and a magnetic resonance imaging of the brain. Results With a median follow-up of 4.1 years (0.3; 8.8 years), a progression event was observed in 109/254 patients (43%). First event consisted in a marker progression only in 47 patients (43%), a radiographic progression only in 35 patients (32%), a mix progression on both markers and imaging in 12 patients (11%) and death in 15 patients (14%). In patients with radiographic progression only, brain was the predominant site (n = 19/35, 54%). Among patients with unfavourable decline who experienced a radiographic progression (as first and subsequent progression event, n = 58), brain was a site of progression in 28 patients (48%): 12/30 (40%) in patients treated with cisplatin, bleomycin and etoposide and 16/28 (57%) in those treated with dose-dense chemotherapy. Conclusions Brain metastases develop often, early and frequently as the only site of relapse in the course of poor-prognosis GCT. This raises the question of early detection and optimal treatment of brain metastases in these patients, e.g. by integrating a systematic brain MRI after 2–3 months of chemotherapy.

AB - Background The GETUG 13 phase III trial tested personalised chemotherapy based on tumour marker decline in patients with poor-prognosis germ-cell tumour (GCT) and demonstrated that a dose-dense regimen improves progression-free survival in patients with an unfavourable decline. We investigated the pattern of relapse for patients included in GETUG 13. Methods We conducted an analysis of relapse events in patients from GETUG 13. Baseline procedures before inclusion in the trial comprised a thoraco-abdomino-pelvic computed tomography scan and a magnetic resonance imaging of the brain. Results With a median follow-up of 4.1 years (0.3; 8.8 years), a progression event was observed in 109/254 patients (43%). First event consisted in a marker progression only in 47 patients (43%), a radiographic progression only in 35 patients (32%), a mix progression on both markers and imaging in 12 patients (11%) and death in 15 patients (14%). In patients with radiographic progression only, brain was the predominant site (n = 19/35, 54%). Among patients with unfavourable decline who experienced a radiographic progression (as first and subsequent progression event, n = 58), brain was a site of progression in 28 patients (48%): 12/30 (40%) in patients treated with cisplatin, bleomycin and etoposide and 16/28 (57%) in those treated with dose-dense chemotherapy. Conclusions Brain metastases develop often, early and frequently as the only site of relapse in the course of poor-prognosis GCT. This raises the question of early detection and optimal treatment of brain metastases in these patients, e.g. by integrating a systematic brain MRI after 2–3 months of chemotherapy.

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