title: Paclitaxel, ifosfamide, and cisplatin (TIP) as salvage and consolidation chemotherapy for advanced germ cell tumor.
abstract: OBJECTIVE
  The purpose of the study was to assess the efficacy of TIP as salvage chemotherapy for germ cell tumor (GCT) patients with relapsed disease or cisplatin (CDDP)-refractory disease and consolidation chemotherapy for patients who responded unfavorably to first-line chemotherapy.
  
  
  METHODS
  Forty-three patients with advanced GCT were treated with TIP. Eleven with relapsed disease and five with CDDP-refractory disease received TIP as salvage chemotherapy. The remaining 27 received TIP as consolidation chemotherapy following initial induction chemotherapy. All patients received prophylactic granulocyte colony-stimulating factor.
  
  
  RESULTS
  In total, 116 cycles of TIP were administered with a median of three cycles (range 1-4 cycles) per patient. Before TIP, 33 patients showed elevated tumor marker and 23 patients (70%) achieved marker normalization with the chemotherapy. One of six (17%) patients with refractory disease and 5 of 10 (50%) patients with relapsed disease achieved durable complete response (CR) after TIP with or without surgery. Eighteen of 27 (67%) patients receiving TIP as consolidation chemotherapy achieved durable CR. Five additional patients were given further chemotherapy and achieved durable CR. Grade 4 leukocytopenia and thrombocytopenia were observed in 91 and 42% of patients, respectively; all were managed with routine supportive care. Grade 2 and grade 3 sensory neuropathy was observed in 37 and 2% of patients, respectively.
  
  
  CONCLUSIONS
  The TIP was effective for relapsed patients with favorable risk features and selected CDDP-refractory GCT patients. Results of TIP as consolidation for patients with unfavorable response to the initial chemotherapy were also encouraging. The toxicities were mainly myelosuppression and sensory neuropathy.
authors: Department of Urology, Faculty of Medicine, Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan, gdechirico1982-igaku@yahoo.co.jp.
authors: Masahiro
authors: M
authors: Kurobe
authors: Koji
authors: K
authors: Kawai
authors: Takehiro
authors: T
authors: Oikawa
authors: Daishi
authors: D
authors: Ichioka
authors: Shuya
authors: S
authors: Kandori
authors: Ei-Ichirou
authors: E
authors: Takaoka
authors: Takahiro
authors: T
authors: Kojima
authors: Akira
authors: A
authors: Joraku
authors: Takahiro
authors: T
authors: Suetomi
authors: Jun
authors: J
authors: Miyazaki
authors: Hiroyuki
authors: H
authors: Nishiyama
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D060830:Consolidation Chemotherapy; D019008:Drug Resistance, Neoplasm / Q000187:drug effects*; D005500:Follow-Up Studies; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D017239:Paclitaxel / Q000008:administration & dosage; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D055815:Young Adult
chemical_list: D017239:Paclitaxel; D002945:Cisplatin; D007069:Ifosfamide