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

Abstract

BACKGROUND:

Etoposide (E) at 100 mg/m2 combined with Cisplatin (P) at 20 mg/m2 represents an induction 2-day regimen embedded in our clinical practice for patients with advanced GCT or TN at high risk of early death. We evaluated 24/7 Em-EP administration to a combined GCT-TN cohort at our Emergency Cancer Treatment Centre (ECTC) to determine its efficacy within the acute setting.

METHODS:

Patients who received Em-EP during a five-year interval were identified from electronic databases at Imperial College Healthcare NHS Trust. Data collected included demographics, treatment details and clinical outcome.

RESULTS:

Em-EP was administered in the emergency setting to 104 patients, predominantly young adults (median age 35, range 17-71). Half the cases were GCT (n = 52): 22 male (6 seminomas, 13 non-seminomas); 30 female (2 dysgerminomas, 28 non-dysgerminomas). The other 50% were treated for TN (n = 52): 45 gestational (GTN) and 7 non-gestational. Most patients received Em-EP for a new cancer diagnosis (n = 100, 96%), within 24 h (n = 93, 89%) and out-of-hours (n = 74, 70%). Indications for Em-EP included symptomatic disease (n = 66, 63%), high-burden disease, (n = 51, 49%) and organ failure requiring Intensive Care Unit support (n = 9, 9%). Neutropenic sepsis was observed in 5%. Four-week overall survival after Em-EP administration was 98%.

CONCLUSIONS:

Despite the potentially fatal complications encountered in the acute setting, early mortality with Em-EP is low at our ECTC. Specialist units that treat unwell patients with advanced GCT or TN should consider making Em-EP available 24/7 for emergency administration. Its efficacy within a prospective cohort and in other platinum-sensitive malignancies requires evaluation.

• Authors: Charleen Chan Wah Hak, Christopher Coyle, Arwa Kocache, Dee Short, Naveed Sarwar, Michael J Seckl, Michael A Gonzalez
• Journal: BMC cancer (BMC Cancer) Vol. 19 Issue 1 Pg. 770 (Aug 05 2019) ISSN: 1471-2407 [Electronic] England
• PMID: 31382912 (Publication Type: Journal Article)

Chemical References

• Antineoplastic Agents, Phytogenic
• Etoposide
• Cisplatin

Topics

• Acute Disease
• Adolescent
• Adult
• Aged
• Antineoplastic Agents, Phytogenic (administration & dosage, adverse effects, therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Cisplatin (administration & dosage, adverse effects, therapeutic use)
• Delivery of Health Care
• Emergency Medical Services
• Etoposide (administration & dosage, adverse effects, therapeutic use)
• Female
• Fever (etiology)
• Follow-Up Studies
• Gestational Trophoblastic Disease (drug therapy, mortality)
• Humans
• Male
• Middle Aged
• Neutropenia (etiology)
• Pregnancy
• Prospective Studies
• Retrospective Studies
• Sepsis (etiology)
• Survival Rate
• Treatment Outcome
• Young Adult