Paclitaxel, ifosfamide, and cisplatin (TIP) as salvage and consolidation chemotherapy for advanced germ cell tumor

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.

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.

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.

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.