Original ResearchSingle-agent carboplatin AUC10 in metastatic seminoma: A multi-centre UK study of 216 patients
Section snippets
Background
The last 30 years have seen an evolution in the treatment of metastatic seminoma to the extent that the majority of men are cured with first line systemic therapy. For patients with low-volume disease, the value of radiotherapy has long been appreciated with cure rates of up to 100% in stage IIA disease using radiotherapy alone. For more bulky disease systemic chemotherapy is preferred by most. Randomised studies in the 1990's established the primacy of three cycles of conventional bleomycin,
Methods and participants
All patients treated with this regimen up to 2018 at three institutions (SBH, UCLH and MVCC) were identified from treatment databases. Patients treated in the original early phase study (n = 20) [15] and CARPET (n = 48) phase II study (NCT02272816) [17] were included alongside an expansion cohort of patients treated subsequently comprising of patients with a histological diagnosis of good-prognosis metastatic seminoma with normal serum alpha-fetoprotein (AFP) levels. These patients were offered
Results
A total of 216 men were treated with carboplatin AUC10. Fig. 1A describes the patient characteristics. The median age was 38, and approximately a third of patients had stage IIA disease (n = 75) with two thirds of patients having stage IIB (n = 69) or above (stage IIC or stage III). Three patients had a primary mediastinal seminoma treated with primary chemotherapy with carboplatin AUC10. The majority of patients were treated with three cycles of carboplatin AUC10 (n = 135). The median
Discussion
We present here a multi-institutional pooled analysis of outcomes in metastatic seminoma using single-agent carboplatin AUC10 delivered as an outpatient in three weekly cycles in 216 patients, with mature follow-up data. The PFS of this approach across all stages of disease is >96% with a three- year disease-specific OS of 100% and a five-year disease-specific OS of 96.5%. Only seven patients of 216 relapsed of their disease, and five of these were salvaged with further chemotherapy. This
Conclusion
Carboplatin AUC10 monotherapy every 21 days is an effective treatment for metastatic seminoma. The higher dose intensity of carboplatin in this protocol than historic regimens is associated with improved efficacy, which is now comparable with those seen using cisplatin-based combination chemotherapy. The specific incidence of febrile neutropenia is lower than that expected with BEP chemotherapy; however the use of platelet and blood product support is greater than that expected with BEP.
Author contribution
Constantine Alifrangis: Study concept, Study design, Data acquisition, Quality control of date and algorithm, Data analysis and interpretation, Statistical analysis, Manuscript preparation, Manuscript editing, Manuscript review. Anand Sharma: Study concept, Study design, Data acquisition, Quality control of date and algorithm, data analysis and interpretation, Statistical analysis, Manuscript review. Shafi Chowdhury. Data acquisition, Manuscript review. Marina Milic: Data acquisition,
Conflict of interest statement
All authors declare no conflict of interest in respect of this manuscript.
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