Initial report of 3^rd line combination chemotherapy comprising gemcitabine, cisplatin and paclitaxel for advanced germ cell carcinoma

Only 20-30% of patients with refractory or recurrent germ cell tumors (GCT) are cured by salvage chemotherapy. Gemcitabine (GEM) and Paclitaxel (PTX) are potent anticancer agents against a variety of solid cancers. The current pilot study investigated the efficacy of third-line and/or salvage combination chemotherapy comprising GEM, PTX and cisplatin (CDDP) for refractory and/or conventional chemotherapy-resistant GCT. The combination chemotherapy consisted of 800 mg/m² GEM, 80 mg/m² PTX and 50 mg/m² on Days 1 and 15, every 3 weeks. A total of five patients, 3 with refractory GCT, one with progressing extragonadal GCT and one with viable cancer cells in the specimen of RPLND received 2-3 cycles of the combination chemotherapy. Four of the patients were assessed for response, and all the patients were assessed for toxicity. The response rate was 75% (partial response). Two of these patients underwent radiation therapy and surgical resection after the chemotherapy, and they continue to show no evidence of disease. However, one patient died of the disease. One patient who received the chemotherapy as an adjuvant therapy remains alive without recurrence. Myelosuppression was the major toxicity, but this was manageable. Gastrointestinal complications were very mild in comparison with other chemotherapies. This pilot study demonstrates that the chemotherapy showed an anticancer activity for patients with refractory GCT, without any serious side effects. Although this study comprised only a few patients, these findings suggest that combination chemotherapy may be one of the options of salvage chemotherapy for patients with refractory and/or conventional chemotherapy-resistant GCT. (Nishinihon J. Urol. 71: 202-207,2009).