Testicular Cancer Treatment Regimens

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TESTICULAR CANCER TREATMENT REGIMENS

Clinical Trials: The NCCN recommends cancer patient participation in clinical trials as the gold standard for treatment.

Cancer therapy selection, dosing, administration, and the management of related adverse events can be a complex process that should be handled by an experienced healthcare team. Clinicians must choose and verify treatment options based on the individual patient; drug dose modifications and supportive care interventions should be administered accordingly. The testicular cancer treatment regimens below may include both U.S. Food and Drug Administration-approved and unapproved indications/regimens. These testicular cancer treatment regimens are only provided to supplement the latest treatment strategies.

These Cancer Treatment Guidelines are a work in progress that may be refined as often as new significant data becomes available. The NCCN Guidelines® are a consensus statement of its authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult any NCCN Guidelines® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient's care or treatment. The National Comprehensive Cancer Network makes no warranties of any kind whatsoever regarding their content, use, or application and disclaims any responsibility for their application or use in any way.

Primary Chemotherapy for Germ Cell Tumors1

Note: All recommendations are category 2A unless otherwise indicated.

(Revised 3/2016)

© 2016 Haymarket Media, Inc.

REGIMEN

DOSING

Etoposide + cisplatin2

Days 1–5: Etoposide 100mg/m2 IV + cisplatin 20mg/m2 IV.

Repeat cycle every 3 weeks for 4 cycles.

Bleomycin + etoposide + cisplatin3

Days 1–5: Cisplatin 20mg/m2 IV + etoposide 100mg/m2 IV

Days 1, 8, and 15 OR Days 2, 9, or 16: Bleomycin 30 units IV weekly.

Repeat cycle every 3 weeks for 3 cycles.

Etoposide + ifosfamide + cisplatin + mesna4

Day 1 (before ifosfamide): Mesna 120mg/m2 by slow IV push

Days 1–5: Etoposide 75mg/m2 IV + mesna 1,200mg/m2 continuous IV infusion + ifosfamide 1,200mg/m2 IV + cisplatin 20mg/m2.

Repeat cycle every 3 weeks for 4 cycles.

Second-Line Chemotherapy For Metastatic Germ Cell Tumors1

Conventional-dose Chemotherapy Regimens

Vinblastine + ifosfamide + cisplatin + mesna5

Days 1–2: Vinblastine 0.11mg/kg IV push; plus

Days 1–5: Mesna 400mg/m2 IV every 8 hours + ifosfamide 1,200mg/m2 IV + cisplatin 20mg/m2 IV.

Repeat cycle every 3 weeks.

Paclitaxel + ifosfamide + mesna + cisplatin6

Day 1: Paclitaxel 250mg/m2 IV

Days 2–5: Ifosfamide 1,500mg/m2 IV + cisplatin 25mg/m2 IV + mesna 500mg/m2 IV before ifosfamide, and then 4 and 8 hours after each dose of ifosfamide.

Repeat cycle every 3 weeks.

High-dose Chemotherapy Regimens

Carboplatin + etoposide7

Carboplatin 700mg/m2 IV + etoposide 750mg/m2 IV.

Administer 5, 4, and 3 days before peripheral blood stem cell infusion for 2 cycles.

Paclitaxel + ifosfamide + mesna + carboplatin + etoposide8

Day 1: Paclitaxel 200mg/m2 IV over 24 hours

Days 2–4: Ifosfamide 2,000mg/m2 over 4 hours with mesna protection

Repeat every 14 days for 2 cycles; followed by

Days 1–3: Carboplatin AUC 7-8mg min/mL IV over 60 minutes + etoposide 400mg/m2 IV.

Administer with peripheral blood stem cell support at 14- to 21-day intervals for 3 cycles.

Subsequent Chemotherapy For Metastatic Germ Cell Tumors1

Gemcitabine + oxaliplatin9–11

Days 1 and 8: Gemcitabine 1,000mg/m2 IV, plus

Day 1: Oxaliplatin 130mg/m2 IV

Repeat cycle every 3 weeks.

OR

Days 1 and 8: Gemcitabine 1,250mg/m2 IV, plus

Day 1: Oxaliplatin 130mg/m2 IV.

Repeat cycle every 3 weeks.

Gemcitabine + paclitaxel12,13

Days 1, 8, and 15: Gemcitabine 1,000mg/m2 IV over 30 minutes + paclitaxel 100mg/m2 IV over 1 hour.

Repeat every 4 weeks for a maximum of 6 cycles.

Gemcitabine + paclitaxel +

oxaliplatin14

Days 1 and 8: Gemcitabine 800mg/m2 IV + paclitaxel 80mg/m2 IV

Day 1: Oxaliplatin 130mg/m2 IV.

Repeat every 3 weeks for at least 2 cycles.

Etoposlde15

Etoposlde 50mg/m2 orally daily until progression or toxicity.

References

1. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology™. Testicular Cancer. v 2.2016. Available at: http://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf. Accessed March 2, 2016.

2. Xiao H, Mazumdar M, Bajorin DF, et al. Long-term follow-up of patients with good-risk germ cell tumors treated with etoposide and cisplatin. J Clin Oncol. 1997;15(7):2553–2558.

3. Saxman SB, Finch D, Gonin R, Einhorn LH. Long-term follow-up of a phase III study of three versus four cycles of bleomycin, etoposide, and cisplatin in favorable-prognosis germ-cell tumors: the Indiana University experience. J Clin Oncol. 1998;16(2):702–706.

4. Nichols CR, Catalano PJ, Crawford ED, et al. Randomized comparison of cisplatin and etoposide and either bleomycin or ifosfamide in treatment of advanced disseminated germ cell tumors: an Eastern Cooperative Oncology Group, Southwest Oncology Group, and Cancer and Leukemia Group B Study. J Clin Oncol. 1998;16(4):1287–1293.

5. Loehrer PJ Sr, Lauer R, Roth BJ, et al. Salvage therapy in recurrent germ cell cancer: ifosfamide and cisplatin plus either vinblastine or etoposide. Ann Intern Med. 1988;109(7): 540–546. Erratum in: Ann Intern Med. 1988;109(10):846.

6. Kondagunta GV, Bacik J, Donadio A, et al. Combination of paclitaxel, ifosfamide, and cisplatin is an effective second-line therapy for patients with relapsed testicular germ cell tumors. J Clin Oncol. 2005;23(27):6549–6555.

7. Einhorn LH, Williams SD, Chamness A, et al. High-dose chemotherapy and stem-cell rescue for metastatic germ-cell tumors. N Engl J Med. 2007;357(4):340–348.

8. Feldman DR, Sheinfeld J, Bajorin DF, et al. TI-CE high-dose chemotherapy for patients with previously treated germ cell tumors: results and prognostic factor analysis. J Clin Oncol. 2010; 28(10):1706–1713. Erratum in: J Clin Oncol. 2010;28(34):5126.

9. Pectasides D, Pectasides M, Farmakis D, et al. Gemcitabine and oxaliplatin (GEMOX) in patients with cisplatin-refractory germ cell tumors: a phase II study. Ann Oncol. 2004;15(3):493–497.

10. Kollmannsberger C, Beyer J, Liersch R, et al. Combination chemotherapy with gemcitabine plus oxaliplatin in patients with intensively pretreated or refractory germ cell cancer: a study of the German Testicular Cancer Study Group. J Clin Oncol. 2004;22(1):108–114.

11. De Giorgi U, Rosti G, Aieta M, et al. Phase II study of oxaliplatin and gemcitabine salvage chemotherapy in patients with cisplatin-refractory nonseminomatous germ cell tumor. Eur Urol. 2006;50(5):1032–1039.

12. Einhorn LH, Brames MJ, Juliar B, Williams SD. Phase II study of paclitaxel plus gemcitabine salvage chemotherapy for germ cell tumors after progression following high-dose chemotherapy with tandem transplant. J Clin Oncol. 2007;25(5):513–516.

13. Mulherin B, Brames MJ, Einhorn L. Long-term survival with paclitaxel and gemcitabine for germ cell tumors after progression following high-dose chemotherapy with tandem transplants. J Clin Oncol. 2011;29(Suppl):Abstract 4562.

14. Bokemeyer C, Oechsle K, Honecker F, et al. Combination chemotherapy with gemcitabine, oxaliplatin, and paclitaxel in patients with cisplatin-refractory or multiply relapsed germ-cell tumors: a study of the German Testicular Cancer Study Group. Ann Oncol. 2008;19(3):448–453.

15. Miller JC, Einhorn LH. Phase II study of daily oral etoposide in refractory germ cell tumors. Semin Oncol. 1990;17 (1 Supp 2):36–39.


Genitourinary Cancer Drug Monographs

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Bladder, Kidney, And Other Urologic Cancers

AFINITOR AVASTIN CABOMETYX
Cisplatin COSMEGEN DEPO-PROVERA
Doxorubicin HCl Doxorubicin HCl Solution INLYTA
LENVIMA NEXAVAR OPDIVO
PROLEUKIN SUTENT TECENTRIQ
Thiotepa TICE BCG TORISEL
VALSTAR VINCASAR PFS VOTRIENT

Prostate And Other Male Cancers

Bleomycin CASODEX Cisplatin
COSMEGEN DELESTROGEN ELIGARD
EMCYT ESTRACE ETOPOPHOS
FIRMAGON Flutamide IFEX
JEVTANA Leuprolide acetate LUPRON DEPOT 7.5mg
LUPRON DEPOT-3 MONTH 22.5mg LUPRON DEPOT-4 MONTH 30mg LUPRON DEPOT-6 MONTH 45mg
MENEST Mitoxantrone HCl NILANDRON
PREMARIN PROVENGE TAXOTERE
TOPOSAR TRELSTAR VANTAS
Vinblastine for injection Vinblastine injection XOFIGO
XTANDI ZOLADEX ZOLADEX 3-MONTH 10.8mg
ZYTIGA

Data provided by the Monthly Prescribing Reference (MPR) Hematology/Oncology Edition.

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