ABSTRACT
INTRODUCTION: Treatment options for patients with platinum refractory metastatic germ cell tumours (GCT) relapsing after high-dose chemotherapy and autologous stem cell transplantation are limited and survival is poor. Antibodies directed against programmed cell death protein-1 (PD-1) and programmed cell death ligand-1 (PD-L1) are currently assessed within clinical trials. We present updated data on our experience with checkpoint inhibitors as a compassionate use off-label treatment attempt for highly-pretreated patients with GCT and provide an overview of the current literature on PD-L1 expression in this rare tumour entity. PATIENTS AND METHODS: We analysed all patients with platinum refractory GCT treated with checkpoint inhibitors at our institutions between 2015 and 2017. Data were retrieved retrospectively from the patient charts. RESULTS: Seven patients were treated with nivolumab or pembrolizumab. Four patients received single-dose treatment and died shortly afterwards due to tumour progression; the remaining three patients received treatment for at least 6 months. No significant treatment toxicity was observed. Long-term tumour response was achieved in two of the three patients, both of them highly positive for PD-L1 staining. INTERPRETATION: We consider checkpoint inhibition to be efficient in carefully selected patients with platinum refractory GCT. However, predictive markers associated with tumour response are not yet known and larger prospective clinical trials are warranted.
Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Antibodies, Monoclonal/therapeutic use , Lung Neoplasms/drug therapy , Mediastinal Neoplasms/drug therapy , Neoplasm Recurrence, Local/drug therapy , Neoplasms, Germ Cell and Embryonal/drug therapy , Testicular Neoplasms/drug therapy , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Choriocarcinoma, Non-gestational/diagnostic imaging , Choriocarcinoma, Non-gestational/drug therapy , Choriocarcinoma, Non-gestational/metabolism , Choriocarcinoma, Non-gestational/secondary , Cisplatin/therapeutic use , Compassionate Use Trials , Endodermal Sinus Tumor/diagnostic imaging , Endodermal Sinus Tumor/drug therapy , Endodermal Sinus Tumor/metabolism , Endodermal Sinus Tumor/secondary , Etoposide/therapeutic use , Humans , Ifosfamide/therapeutic use , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/secondary , Male , Mediastinal Neoplasms/metabolism , Mediastinal Neoplasms/pathology , Middle Aged , Neoplasms, Germ Cell and Embryonal/diagnostic imaging , Neoplasms, Germ Cell and Embryonal/metabolism , Neoplasms, Germ Cell and Embryonal/secondary , Nivolumab , Platinum Compounds/administration & dosage , Programmed Cell Death 1 Receptor/metabolism , Retrospective Studies , Seminoma/diagnostic imaging , Seminoma/drug therapy , Seminoma/metabolism , Seminoma/secondary , Stem Cell Transplantation , Teratoma , Testicular Neoplasms/metabolism , Testicular Neoplasms/pathology , Tomography, X-Ray Computed , Transplantation, Autologous , Treatment OutcomeABSTRACT
PURPOSE: The aim of this study was to evaluate the quality of care and interdisciplinary cooperation in the palliative treatment of colorectal cancer (CRC), including the associated costs. PATIENTS AND METHODS: 103 patients were enrolled from 13 institutions to reflect the existing clinical treatment reality and costs of palliative CRC treatment. We present the clinical outcome of the patients and compare the results obtained in the 3 centers with double-figure recruitment numbers (centers A, B, and C). RESULTS: First-line treatment with 5-fluorouracil monotherapy was applied in exceptional cases. The regular treatment method comprised either an irinotecan- (30%) or an oxaliplatin-based regimen (32%). Biological agents were added to the treatment of 33 patients (32%). The median overall survival (OS) of the total patient collective was 25 months. The OS differed significantly in 2 out of the 3 centers, ranging between 27 and 11 months. Secondary metastasis resections were performed in 26% of the total patient collective. The center with the most favorable outcome results also had the lowest costs for palliative treatment and care, including the lowest drug costs. CONCLUSION: A combined chemotherapy treatment was the rule. Concerning biological agents, a significant lack of their application in first-line treatment and the quality of interdisciplinary cooperation have to be addressed.