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Emergency Etoposide-Cisplatin (Em-EP) for patients with germ cell tumours (GCT) and trophoblastic neoplasia (TN)
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Emergency Etoposide-Cisplatin (Em-EP) for patients with germ cell tumours (GCT) and trophoblastic neoplasia (TN)
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Journal Article
Emergency Etoposide-Cisplatin (Em-EP) for patients with germ cell tumours (GCT) and trophoblastic neoplasia (TN)
2019
Overview
Background
Etoposide (E) at 100 mg/m
2
combined with Cisplatin (P) at 20 mg/m
2
represents an induction 2-day regimen embedded in our clinical practice for patients with advanced GCT or TN at high risk of early death. We evaluated 24/7 Em-EP administration to a combined GCT-TN cohort at our Emergency Cancer Treatment Centre (ECTC) to determine its efficacy within the acute setting.
Methods
Patients who received Em-EP during a five-year interval were identified from electronic databases at Imperial College Healthcare NHS Trust. Data collected included demographics, treatment details and clinical outcome.
Results
Em-EP was administered in the emergency setting to 104 patients, predominantly young adults (median age 35, range 17–71). Half the cases were GCT (
n
= 52): 22 male (6 seminomas, 13 non-seminomas); 30 female (2 dysgerminomas, 28 non-dysgerminomas). The other 50% were treated for TN (
n
= 52): 45 gestational (GTN) and 7 non-gestational. Most patients received Em-EP for a new cancer diagnosis (
n
= 100, 96%), within 24 h (
n
= 93, 89%) and out-of-hours (
n
= 74, 70%). Indications for Em-EP included symptomatic disease (
n =
66, 63%), high-burden disease, (
n =
51, 49%) and organ failure requiring Intensive Care Unit support (
n =
9, 9%). Neutropenic sepsis was observed in 5%. Four-week overall survival after Em-EP administration was 98%.
Conclusions
Despite the potentially fatal complications encountered in the acute setting, early mortality with Em-EP is low at our ECTC. Specialist units that treat unwell patients with advanced GCT or TN should consider making Em-EP available 24/7 for emergency administration. Its efficacy within a prospective cohort and in other platinum-sensitive malignancies requires evaluation.
Publisher
BioMed Central,BioMed Central Ltd,BMC
Subject
/ Adult
/ Aged
/ Antineoplastic Agents, Phytogenic - administration & dosage
/ Antineoplastic Agents, Phytogenic - adverse effects
/ Antineoplastic Agents, Phytogenic - therapeutic use
/ Antineoplastic Combined Chemotherapy Protocols - adverse effects
/ Antineoplastic Combined Chemotherapy Protocols - therapeutic use
/ Biomedical and Life Sciences
/ Cancer
/ Cisplatin - administration & dosage
/ Complications and side effects
/ Death
/ Etoposide - administration & dosage
/ Female
/ Gestational Trophoblastic Disease - drug therapy
/ Gestational Trophoblastic Disease - mortality
/ Health Promotion and Disease Prevention
/ Humans
/ Male
/ Medical and radiation oncology
/ Oncology
/ Tumors
/ Youth
