title: Long-term results of a combination of paclitaxel, cisplatin and gemcitabine for salvage therapy in male germ-cell tumours.
abstract: OBJECTIVE
  To retrospectively review the long-term activity, efficacy and toxicity of the combination of paclitaxel, cisplatin and gemcitabine (TPG) as third- or further-line chemotherapy in patients with germ-cell tumours (GCTs) who are not cured after at least two courses of standard-dose chemotherapy, high-dose chemotherapy or both.
  
  
  METHODS
  We evaluated 22 consecutive men treated between April 1999 and December 2000. Half of them were classified as absolutely refractory to cisplatin and a further two as refractory. The median (range) number of previous courses of chemotherapy was 8 (5-11). Treatment consisted of paclitaxel 80 mg/m(2), cisplatin 50 mg/m(2) and gemcitabine 800 mg/m(2) on days 1 and 8, every 3 weeks for four courses, followed by surgery of actual residual resectable masses.
  
  
  RESULTS
  The follow-up was updated at August 2007. There were no deaths from toxicity and only one patient needed suspension of therapy for toxicity. There was both grade 3-4 thrombocytopenia and neutropenia in 15 patients (68%), and anaemia in nine (41%). There were partial remissions in eight (36%) patients. Six (27%) patients were rendered disease-free with surgical removal of a residual mass after chemotherapy (two still containing viable cancer). Four (18%) patients are long-term survivors at more than 80, 81, 94 and 99 months. The median (range) overall survival of the whole series was 13.5 (1->99) months.
  
  
  CONCLUSIONS
  This combination had a toxicity profile that was acceptable and comparable with other third-line regimens. There were eight (36%) major responses. After a 6-year minimum follow-up, four (18%) patients were long-term disease-free survivors.
authors.affiliation: Urology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Nicolai
authors.forename: Andrea
authors.initials: A
authors.lastname: Necchi
authors.forename: Luca
authors.initials: L
authors.lastname: Gianni
authors.forename: Luigi
authors.initials: L
authors.lastname: Piva
authors.forename: Davide
authors.initials: D
authors.lastname: Biasoni
authors.forename: Tullio
authors.initials: T
authors.lastname: Torelli
authors.forename: Silvia
authors.initials: S
authors.lastname: Stagni
authors.forename: Angelo
authors.initials: A
authors.lastname: Milani
authors.forename: Giorgio
authors.initials: G
authors.lastname: Pizzocaro
authors.forename: Roberto
authors.initials: R
authors.lastname: Salvioni
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004812:Epidemiologic Methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy*; D017239:Paclitaxel / Q000008:administration & dosage; D012074:Remission Induction; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods*; D017741:Survivors; D013736:Testicular Neoplasms / Q000188:drug therapy*; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D017239:Paclitaxel; D002945:Cisplatin; D000093542:Gemcitabine