Phase 2 analysis on Covid-19-adopted etoposide (E) and cisplatin (P) regimens for patients (pts) with an advanced germ cell tumor (GCT): The CovGCT study.

Authors

null

Nabeel Naban

Imperial College Healthcare NHS Trust, London, United Kingdom

Nabeel Naban , Gesa Tiemeier , Arwa Kocache , Rory Taylor , Georgina Keogh , Lindsay Hennah , Naveed Sarwar , Michael Seckl , Michael Gonzalez

Organizations

Imperial College Healthcare NHS Trust, London, United Kingdom, Charing Cross Hospital, Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom

Research Funding

No funding received
None

Background: The Covid19 pandemic has imposed risks to healthcare delivery for all cancer pts including young adults diagnosed with a GCT. Here, we examine Emergency EP (EmEP, Cohort A) and a novel 1-day Escalated-dose EP (EscEP, Cohort B) administered every 2 weeks as upfront or first-relapse therapy to minimise hospital days. Methods: Single-centre analysis in GCT pts receiving emergency and routine chemotherapy following our first National lockdown on 23rd March 2020. In Cohort A, eligible pts receive EmEP E100mg/m2, P20mg/m2 prior to EscEP within the acute setting as previously defined. In Cohort B, EscEP E500mg/m2, P60mg/m2 is compared to standard care chemotherapy BEP or POMB-ACE. Data collection includes demographics, treatment details, clinical outcome and Covid19 complications. Results: To date, we have accrued 19 pts with a median age 32 (range 18 to 65). In Cohort A, 7 pts with symptomatic high-volume disease received a median 1 cycle EmEP, 6/7 for a new GCT diagnosis and 1/7 for a first relapse, including 2 males with IGCCCG intermediate-prognosis disease, 5 females with FIGO Stage III (n = 2) and IV (n = 3) disease. One pt required higher-level support for organ dysfunction at presentation. In Cohort B, 19 pts including 7 pts from Cohort A received a median 4 cycles EscEP: 8 males (2 seminomas, 6 non-seminomas; IGCCCG good-prognosis in 4, intermediate-prognosis in 2, poor-prognosis in 2), 11 females (1 dysgerminoma, 10 non-dysgerminomas; FIGO Stage Ic in 6, III in 2, IV in 3). A majority (14/19, 74%) received EscEP for a new cancer diagnosis, 5/19 (26%) for a first relapse. Total median hospital stay: EscEP 5 days, BEP 21 days, POMB-ACE 28 days. Grade 3/4 neutropenic events: EscEP 28%, BEP 50%, POMB-ACE 43%. From April 2020, 16/16 pts were SARS-CoV-2 screened prior to each cycle: 3/19 (16%) testing positive, one prior to intubation and ventilation, 2 with asymptomatic infection. For Cohort B, at median follow-up 121 days (range 9-323 days), we have observed a complete response in 10 pts (53%), partial response in 3 pts (16%) and disease progression in 1 pt (5%). Five pts are still on treatment (26%). All pts remain alive. Conclusions: EmEP and EscEP represent safe options during the pandemic that minimise myelosuppression and total length in hospital days whilst bypassing the potential pulmonary toxicity from Bleomycin. Further follow-up will inform on long-term efficacy including a multicentre evaluation.

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Genitourinary Cancer—Prostate, Testicular, and Penile

Track

Genitourinary Cancer—Prostate, Testicular, and Penile

Sub Track

Germ Cell/Testicular Cancer

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr e17013)

DOI

10.1200/JCO.2021.39.15_suppl.e17013

Abstract #

e17013

Abstract Disclosures