The importance of etoposide dose intensity in the management of metastatic germ cell tumours and the role of paclitaxel in salvage treatment of relapsing patients
Bibliographic record
Abstract
14502 Background: The primary objective was to evaluate the effect of etoposide dose intensity in the standard cisplatin/etoposide/bleomycin (PEB) regimen on progression free (PFS) and overall survival (OS). Secondary objectives were and to determine how the addition of paclitaxel in salvage regimens impacts OS and to compare the risk distribution of germ cell patients seen at a tertiary care centre to that quoted in the International Germ Cell Consensus Classification (IGCCC). Methods: A retrospective chart review of all 302 germ cell patients requiring cisplatin-based chemotherapy between January 1980 and December 2004 was conducted. Data collected on initial treatment included the dose of etoposide: 500 mg/m2/cycle (E500) or 360 mg/m2/cycle (E360) and whether the salvage treatment contained paclitaxel or not. PFS and OS were calculated. Patients were risk stratified as per IGCCC variables. Results: In the PEB regimen, E500 is superior to E360 as it results in a relapse rate of only 3% and an overall survival of 97% compared to a relapse rate and survival of 29% and 80% respectively. The addition of paclitaxel to salvage chemotherapy regimens for patients relapsing results in 1/5 (20%) of patients dying compared to 26/39 (67%) for those receiving a non-paclitaxel based salvage regimen. The distribution of seminoma patients was similar to the IGCCC (90% good risk, 10% intermediate risk). Non-seminoma (NS) patients were skewed to the good-risk category: 71% good risk, 10% intermediate risk and 18% poor risk as compared to 56%, 28% and 16% respectively as reported by the IGCCC. 5-year PFS and OS were comparable to those documented by the IGCCC with the exception of the intermediate risk NS patients where our 5 year PFS was 48% compared to 75% expected but 5 year OS was similar in these patients (75% Vs. 80%). Conclusions: This review demonstrates that PEB treatment containing higher dose etoposide is superior in terms of PFS and OS. Although the sample size is small it appears that Paclitaxel containing salvage regimens results in superior outcomes compared to previously used salvage regimens. Our centre has a similar risk distribution of patients as that quoted by the IGCCC. No significant financial relationships to disclose.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".