Brain metastases in patients with germ cell tumors: Prognostic factors and treatment options - An analysis from the Global Germ Cell Cancer Group

Darren R. Feldman, Anja Lorch, Andrew Kramar, Costantine Albany, Lawrence Einhorn, Patrizia Giannatempo, Andrea Necchi, Aude Flechon, Helen Boyle, Peter Chung, Robert A. Huddart, Carsten Bokemeyer, Alexey Tryakin, Teodoro Sava, Eric William Winquist, Ugo De Giorgi, Jorge Aparicio, Christopher J. Sweeney, Gabriella Cohn Cedermark, Jörg BeyerThomas Powles

Research output: Contribution to journalArticle

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Abstract

Purpose: To define characteristics, treatment response, and outcomes of men with brain metastases (BM) from germ cell tumors (GCT). Patients and Methods: Data from 523 men with BM from GCT were collected retrospectively from 46 centers in 13 countries by using standardized questionnaires. Clinical features were correlated with overall survival (OS) as the primary end point. Results: BM were present at initial diagnosis in 228 men (group A) and at relapse in 295 men (group B). OS at 3 years (3-year OS) was superior in group A versus group B (48% v27%; P <.001). Multiple BM and the presence of liver or bone metastasis were independent adverse prognostic factors in both groups; primary mediastinal nonseminoma (group A) and elevations of α-fetoprotein of 100 ng/mL or greater or of human chorionic gonadotropin of 5,000 U/L or greater (group B) were additional independent adverse prognostic factors. Depending on these factors, the 3-year OS ranged from 0% to 70% in group A and from 6% to 52% in group B. In group A, 99% of patients received chemotherapy; multimodality treatment or high-dose chemotherapy was not associated with statistically improved survival in multivariable analysis. In group B, only 54% of patients received chemotherapy; multimodality treatment was associated with improved survival compared with single-modality therapy (hazard ratio, 0.51; 95% CI, 0.36 to 0.73; P <.001), as was high-dose compared with conventional-dose chemotherapy (hazard ratio, 0.41; 95% CI, 0.24 to 0.70; P = .001). Conclusion: Men with BM from GCT have poor OS, particularly if additional risk factors are present. High-dose chemotherapy and multimodality treatment seemed to improve survival probabilities in men with BM at relapse.

Original languageEnglish (US)
Pages (from-to)345-351
Number of pages7
JournalJournal of Clinical Oncology
Volume34
Issue number4
DOIs
StatePublished - Feb 1 2016

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Germ Cell and Embryonal Neoplasms
Neoplasm Metastasis
Survival
Brain
Drug Therapy
Therapeutics
Fetal Proteins
Recurrence
Chorionic Gonadotropin
Bone and Bones
Liver

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Brain metastases in patients with germ cell tumors : Prognostic factors and treatment options - An analysis from the Global Germ Cell Cancer Group. / Feldman, Darren R.; Lorch, Anja; Kramar, Andrew; Albany, Costantine; Einhorn, Lawrence; Giannatempo, Patrizia; Necchi, Andrea; Flechon, Aude; Boyle, Helen; Chung, Peter; Huddart, Robert A.; Bokemeyer, Carsten; Tryakin, Alexey; Sava, Teodoro; Winquist, Eric William; De Giorgi, Ugo; Aparicio, Jorge; Sweeney, Christopher J.; Cedermark, Gabriella Cohn; Beyer, Jörg; Powles, Thomas.

In: Journal of Clinical Oncology, Vol. 34, No. 4, 01.02.2016, p. 345-351.

Research output: Contribution to journalArticle

Feldman, DR, Lorch, A, Kramar, A, Albany, C, Einhorn, L, Giannatempo, P, Necchi, A, Flechon, A, Boyle, H, Chung, P, Huddart, RA, Bokemeyer, C, Tryakin, A, Sava, T, Winquist, EW, De Giorgi, U, Aparicio, J, Sweeney, CJ, Cedermark, GC, Beyer, J & Powles, T 2016, 'Brain metastases in patients with germ cell tumors: Prognostic factors and treatment options - An analysis from the Global Germ Cell Cancer Group', Journal of Clinical Oncology, vol. 34, no. 4, pp. 345-351. https://doi.org/10.1200/JCO.2015.62.7000
Feldman, Darren R. ; Lorch, Anja ; Kramar, Andrew ; Albany, Costantine ; Einhorn, Lawrence ; Giannatempo, Patrizia ; Necchi, Andrea ; Flechon, Aude ; Boyle, Helen ; Chung, Peter ; Huddart, Robert A. ; Bokemeyer, Carsten ; Tryakin, Alexey ; Sava, Teodoro ; Winquist, Eric William ; De Giorgi, Ugo ; Aparicio, Jorge ; Sweeney, Christopher J. ; Cedermark, Gabriella Cohn ; Beyer, Jörg ; Powles, Thomas. / Brain metastases in patients with germ cell tumors : Prognostic factors and treatment options - An analysis from the Global Germ Cell Cancer Group. In: Journal of Clinical Oncology. 2016 ; Vol. 34, No. 4. pp. 345-351.
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abstract = "Purpose: To define characteristics, treatment response, and outcomes of men with brain metastases (BM) from germ cell tumors (GCT). Patients and Methods: Data from 523 men with BM from GCT were collected retrospectively from 46 centers in 13 countries by using standardized questionnaires. Clinical features were correlated with overall survival (OS) as the primary end point. Results: BM were present at initial diagnosis in 228 men (group A) and at relapse in 295 men (group B). OS at 3 years (3-year OS) was superior in group A versus group B (48{\%} v27{\%}; P <.001). Multiple BM and the presence of liver or bone metastasis were independent adverse prognostic factors in both groups; primary mediastinal nonseminoma (group A) and elevations of α-fetoprotein of 100 ng/mL or greater or of human chorionic gonadotropin of 5,000 U/L or greater (group B) were additional independent adverse prognostic factors. Depending on these factors, the 3-year OS ranged from 0{\%} to 70{\%} in group A and from 6{\%} to 52{\%} in group B. In group A, 99{\%} of patients received chemotherapy; multimodality treatment or high-dose chemotherapy was not associated with statistically improved survival in multivariable analysis. In group B, only 54{\%} of patients received chemotherapy; multimodality treatment was associated with improved survival compared with single-modality therapy (hazard ratio, 0.51; 95{\%} CI, 0.36 to 0.73; P <.001), as was high-dose compared with conventional-dose chemotherapy (hazard ratio, 0.41; 95{\%} CI, 0.24 to 0.70; P = .001). Conclusion: Men with BM from GCT have poor OS, particularly if additional risk factors are present. High-dose chemotherapy and multimodality treatment seemed to improve survival probabilities in men with BM at relapse.",
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T1 - Brain metastases in patients with germ cell tumors

T2 - Prognostic factors and treatment options - An analysis from the Global Germ Cell Cancer Group

AU - Feldman, Darren R.

AU - Lorch, Anja

AU - Kramar, Andrew

AU - Albany, Costantine

AU - Einhorn, Lawrence

AU - Giannatempo, Patrizia

AU - Necchi, Andrea

AU - Flechon, Aude

AU - Boyle, Helen

AU - Chung, Peter

AU - Huddart, Robert A.

AU - Bokemeyer, Carsten

AU - Tryakin, Alexey

AU - Sava, Teodoro

AU - Winquist, Eric William

AU - De Giorgi, Ugo

AU - Aparicio, Jorge

AU - Sweeney, Christopher J.

AU - Cedermark, Gabriella Cohn

AU - Beyer, Jörg

AU - Powles, Thomas

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Purpose: To define characteristics, treatment response, and outcomes of men with brain metastases (BM) from germ cell tumors (GCT). Patients and Methods: Data from 523 men with BM from GCT were collected retrospectively from 46 centers in 13 countries by using standardized questionnaires. Clinical features were correlated with overall survival (OS) as the primary end point. Results: BM were present at initial diagnosis in 228 men (group A) and at relapse in 295 men (group B). OS at 3 years (3-year OS) was superior in group A versus group B (48% v27%; P <.001). Multiple BM and the presence of liver or bone metastasis were independent adverse prognostic factors in both groups; primary mediastinal nonseminoma (group A) and elevations of α-fetoprotein of 100 ng/mL or greater or of human chorionic gonadotropin of 5,000 U/L or greater (group B) were additional independent adverse prognostic factors. Depending on these factors, the 3-year OS ranged from 0% to 70% in group A and from 6% to 52% in group B. In group A, 99% of patients received chemotherapy; multimodality treatment or high-dose chemotherapy was not associated with statistically improved survival in multivariable analysis. In group B, only 54% of patients received chemotherapy; multimodality treatment was associated with improved survival compared with single-modality therapy (hazard ratio, 0.51; 95% CI, 0.36 to 0.73; P <.001), as was high-dose compared with conventional-dose chemotherapy (hazard ratio, 0.41; 95% CI, 0.24 to 0.70; P = .001). Conclusion: Men with BM from GCT have poor OS, particularly if additional risk factors are present. High-dose chemotherapy and multimodality treatment seemed to improve survival probabilities in men with BM at relapse.

AB - Purpose: To define characteristics, treatment response, and outcomes of men with brain metastases (BM) from germ cell tumors (GCT). Patients and Methods: Data from 523 men with BM from GCT were collected retrospectively from 46 centers in 13 countries by using standardized questionnaires. Clinical features were correlated with overall survival (OS) as the primary end point. Results: BM were present at initial diagnosis in 228 men (group A) and at relapse in 295 men (group B). OS at 3 years (3-year OS) was superior in group A versus group B (48% v27%; P <.001). Multiple BM and the presence of liver or bone metastasis were independent adverse prognostic factors in both groups; primary mediastinal nonseminoma (group A) and elevations of α-fetoprotein of 100 ng/mL or greater or of human chorionic gonadotropin of 5,000 U/L or greater (group B) were additional independent adverse prognostic factors. Depending on these factors, the 3-year OS ranged from 0% to 70% in group A and from 6% to 52% in group B. In group A, 99% of patients received chemotherapy; multimodality treatment or high-dose chemotherapy was not associated with statistically improved survival in multivariable analysis. In group B, only 54% of patients received chemotherapy; multimodality treatment was associated with improved survival compared with single-modality therapy (hazard ratio, 0.51; 95% CI, 0.36 to 0.73; P <.001), as was high-dose compared with conventional-dose chemotherapy (hazard ratio, 0.41; 95% CI, 0.24 to 0.70; P = .001). Conclusion: Men with BM from GCT have poor OS, particularly if additional risk factors are present. High-dose chemotherapy and multimodality treatment seemed to improve survival probabilities in men with BM at relapse.

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