A randomized phase III study comparing standard dose BEP with sequential high-dose cisplatin, etoposide, and ifosfamide (VIP) plus stem-cell support in males with poor-prognosis germ-cell cancer. An intergroup study of EORTC, GTCSG, and Grupo Germinal (EORTC 30974)

BACKGROUND

To compare the efficacy of one cycle of standard dose cisplatin, etoposide, and ifosfamide (VIP) plus three cycles of high-dose VIP followed by stem-cell infusion [high-dose chemotherapy (HD-CT arm)] to four cycles of standard cisplatin, etoposide, and bleomycin (BEP) in patients with poor-prognosis germ-cell cancer (GCC).

PATIENT AND METHODS

Patients with poor-prognosis GCC were assigned to receive either BEP or VIP followed by HD-CT. To show a 15% improvement in a 1-year failure-free survival (FFS), the study aimed to recruit 222 patients but closed with 137, due to slow accrual.

RESULTS

One hundred thirty-one patients were included in this analysis. The complete response rates in the HD-CT and in the BEP arm did not differ: (intention to treat) 44.6% versus 33.3% (P = 0.18). There was no difference in FFS between the two treatment arms (P = 0.057, 66 events). At 2 years, the FFS rate was 44.8% [95% confidence interval (CI) 32.5-56.4] and 58.2%, respectively (95% CI 48.0-71.9); but this 16.3% (standard deviation 7.5%) difference was not statistically significant (P = 0.060). Overall survival did not differ between the two groups (log-rank P > 0.1, 47 deaths).

CONCLUSION

This study could not demonstrate that high-dose chemotherapy given as part of first-line therapy improves outcome in patients with poor-prognosis GCC.

Docetaxel plus oblimersen sodium (Bcl-2 antisense oligonucleotide): an EORTC multicenter, randomized phase II study in patients with castration-resistant prostate cancer

BACKGROUND

This randomized, phase II study assessed the activity of oblimersen sodium, a Bcl-2 antisense oligonucleotide, administered before docetaxel (Taxotere) to patients with castration-resistant prostate cancer.

PATIENTS AND METHODS

Chemotherapy-naive patients with prostate-specific antigen (PSA) progression and testosterone < or = 0.5 ng/ml received docetaxel 75 mg/m2 on day 1 or oblimersen 7 mg/kg/day continuous i.v. infusion on days 1-7 with docetaxel 75 mg/m2 on day 5 every 3 weeks for < or = 12 cycles. Primary end points were confirmed PSA response (Bubley criteria) and major toxic events.

RESULTS

Confirmed PSA response was observed in 46% and 37% of 57 and 54 patients treated with docetaxel and docetaxel-oblimersen, respectively. Partial response (RECIST) was achieved in 18% and 24%, respectively. Oblimersen added to docetaxel was associated with an increase in the incidence of grade > or = 3 fatigue, mucositis, and thrombocytopenia. Major toxic events were reported in 22.8% and 40.7% of patients with docetaxel and docetaxel-oblimersen, respectively.

CONCLUSIONS

The primary end points of the study were not met: a rate of confirmed PSA response >30% and a major toxic event rate <45% were not observed with docetaxel-oblimersen.

Diagnosis of local relapse after radical radiotherapy (RRTH) of prostate cancer by biochemical PSA kinetics and transrectal ultrasonography (TRUS) verified by prostate biopsy

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Background: Patients (pts) with the cancer of the prostate after radical radiotherapy (RRTH) are followed by clinical examination, periodical measurements of PSA level, bone scan, bone x-ray examinations, CT of abdomen and pelvis. The biochemical progression (according ASTRO Consensus Panel) is not always equal the clinical progression. The next step in all cases of rising PSA is to diagnose or to exclude the local progression, which has to be distinguished from systemic progression. Methods: Prospective evaluation of effectiveness of the biochemical indicators as predictors of local relapse after RRTH and probability of positive tru-cut biopsy outcome in case of positive TRUS result. 51 pts with prostatic adenocarcinoma after RRTH, who experienced biochemical (PSA) progression were included. All of them had a negative bone scan results, negative abdomen-pelvis CT scan or ultrasonography and no clinical evidence of distant metastases. All pts underwent a tru-cut biopsy guided by TRUS. Each of them were eligible to local salvage procedures. The TRUS-guided tru-cut biopsy were performed in all pts. Results: The median observation time (between RRTH and biopsy) was 34 mo (11–78). The median PSA level at the biopsy was 2.46 ng/ml (0,69–11,26). TRUS was positive in 20/51 pts. In 31 pts, there was no evidence of local progression in TRUS. TRUS specificity was 62.02% (95% CI 48.75–75.39%) and sensitivity 40.91% (95% CI 27.42%–54.40). The biopsy outcome was positive in 22/51 pts (43%). The biopsy was positive in 58% (25/26) in subgroup with PSA level lower than 2.46 ng/ml and 27% (7/25) in group with PSA upper to this value. There were no significant associations between positive biopsy outcome and PSA velocity. Conclusions: In pts with suspicion of local relapse we observed the low predictive value of PSA level at biopsy (area under ROC curve = 0.6113). There were no associations between positive biopsy outcome and PSADT (PSA doubling time) which could help in better selection for invasive procedure.

No significant financial relationships to disclose.

Germ cell-like telomeric length homeostasis in nonseminomatous testicular germ cell tumors

Telomere maintenance plays an important role in cell proliferation and tumor survival. Human male germ cells, which carry long telomeres and express telomerase, give rise to a highly heterogeneous group of malignant tumors. We compared telomeric length and telomerase activity between two major histological types of primary testicular germ cell tumors. Fifteen out of 16 seminoma samples revealed telomeric restriction fragment (TRF) length below 13 kb; the remaining seminoma showed a major TRF fraction of 18 kb and a distinct minor fraction of above 23 kb length. In contrast, all 13 samples from nonseminomas showed TRF length >/=23 kb, which is similar to that reported in human sperm. Nine out of 11 seminoma specimens and six out of seven nonseminomas studied showed moderate to high telomerase activity, the only telomerase-negative nonseminoma being pure mature teratoma. These results indicate to a major difference in telomeric length between seminomas and nonseminomas, which is apparently unrelated to the presence of telomerase activity, and suggest a germline-like homeostasis of telomeric length is preserved in human nonseminomas. Oncogene (2000) 19, 4075 - 4078.

A report comparing the use of tropisetron (Navoban), a 5-HT3 antagonist, with a standard antiemetic regimen of dexamethasone and metoclopramide in cisplatin-treated patients under conditions of severe emesis

This report of a double-blind, randomized study performed to evaluate the comparative antiemetic efficacy of tropisetron (Navoban; Sandoz Pharma Ltd, Basel, Switzerland), a new 5-hydroxytryptamine receptor antagonist, focuses on treatment during stages of chemotherapy when nausea and vomiting are particularly severe. One hundred fifteen chemotherapy-naive patients with malignant disease were administered either tropisetron (n = 58) or a dexamethasone dose plus a metoclopramide dose (n = 57) during 5 days of two successive cycles of chemotherapy. Within the first 24 hours after receiving cisplatin-based chemotherapy, 76% of patients in the tropisetron group remained free of vomiting (with 59% of patients free of nausea) compared with 39% of patients free of vomiting in the conventionally treated group (30% of patients free of nausea). Improved control of emesis also was observed over 4 consecutive days of follow-up in the tropisetron group. The difference in incidence of nausea and vomiting between the patient groups was statistically significant (P < .05). The efficacy of tropisetron was well maintained during the second consecutive chemotherapy cycle; during the first 24 hours, 72% and 62% of patients remained free of vomiting and nausea, respectively. Tropisetron appears to be a highly effective, well tolerated, and simple to use antiemetic agent for patients receiving chemotherapy.