Sparse data are available with regard to the incidence, clinical characteristics, therapeutic man... more Sparse data are available with regard to the incidence, clinical characteristics, therapeutic management and prognosis of male patients with germ cell tumors, who relapse more than two years after completion of cisplatin-based chemotherapy. A review of 530 patients treated at two institutions from 1978 to April 1994 was conducted. Twenty-five cases of late relapse were identified. Cumulative risk of late relapse was calculated according to the Kaplan-Meier method. 418 of 523 patients (80%) who received their first-line treatment at our institutions were relapse-free at two years. Among these 418 patients 18 cases (4.3%) developed a late relapse. The cumulative risk of late relapse was 1.1% at five years and 4.0% at ten years excluding patients with prior early relapses who carried risks of 9.4% and 29%, respectively (P < 0.0001). No case of late relapse was observed among patients receiving adjuvant chemotherapy. The risk of late relapse was lower in patients with good-risk non-seminomatous germ cell tumors than in poor-risk patients according to Medical Research Council criteria (P < 0.01). Seven further patients were referred from other institutions for treatment of late relapse. At a median follow-up of 38 months (range, 3 to 121) after treatment of late relapse 9 of 25 patients (36%) are continuously disease-free. Six of these nine patients had surgical resection of carcinoma or teratoma as a component of their therapy. The incidence of late relapse after cisplatin-based chemotherapy of germ cell tumors is related to initial tumor burden and is somewhat higher than previously expected. Chemotherapy seems to have only minor curative potential, but localized resectable disease can be cured by surgery. Annual follow-up evaluations allow to detect the majority of late relapses at an asymptomatic stage and should be extended throughout the patient's life.
8046 Background: The high prognostic value of FDG-PET/CT performed after 2 cycles of chemotherapy... more 8046 Background: The high prognostic value of FDG-PET/CT performed after 2 cycles of chemotherapy for HIV negative Hodgkin lymphoma (HL) is well known. However, experience with PET in HIV-related HL needs to be further studied as nodal FDG uptake can be observed in various opportunistic infections and AIDS-related conditions. Methods: A total of 45 consecutive HL patients (pts) were enrolled in 10 centers from the GECAT. There were 42 males and 3 females. Median age was 46 yo, range [26;64]. Median CD4 count was 391/mm3, range [33;1191]. Viral load was negative in 38 pts (84%) and uncontrolled in 5 pts (11%). Forthy three pts (96%) received concomitant HAART. HL was staged III-IV in 25 pts. International Prognostic Index scored 3-5 in 24 pts. All PET studies were performed after 2 ABVD cycles. They were scored, blinded to treatment outcome, according to the 5-point Deauville visual scale. It was considered as negative when scored 1-3 (i.e tumor FDG uptake less or equal than liver uptake) and positive when scored 4-5 (i.e. more than liver uptake or new lesions). Chemotherapy was not modified : 4-8 cycles of ABVD, as initially planned. Results: Overall, 35 pts (78%) achieved a CR after the end of treatment. Three pts received Involved Field Radiation Therapy. At a median follow-up of 18 months, 3 pts relapsed and 2 of them died from HL. The 2 yr OS and PFS were estimated at 94 and 90%, respectively. PET after 2 cycles of ABVD was negative in 40 pts (89%) and positive in 5 pts (11%). Patients with negative PET had a significantly better outcome than those with positive PET in term of 2 yr PFS (94% vs 60%, P=0.005), and 2 yr OS (100% vs 60%, P=0.0002). The negative predictive value was estimated at 97% and specificity at 93%. All patients who were PET-negative after the 2nd cycle stayed PET-negative after the 4th cycle and entered a durable CR. Conclusions: This largest study in HIV-positive HL showed that interim PET could play a central role in driving risk-tailored treatment. In further studies, de-escalation strategies should be tested for patients responding after 2 cycles of ABVD and those not reponding should be managed with intensive salvage strategies.
Non-AIDS-defining malignancies (NADM) are a leading cause of morbidity and mortality for HIV-infe... more Non-AIDS-defining malignancies (NADM) are a leading cause of morbidity and mortality for HIV-infected subjects. The risk of testicular germ cell cancer (GCC) and renal cell cancer is slightly increased in the setting of HIV, whereas there is a slightly decreased risk of prostate cancer and bladder cancer. As in industrialized countries the majority of people living with HIV are men, and people aged 55 and older now account for more than a quarter of persons living with HIV, both testis and prostate cancer are assumed to occur with increased frequency in HIV-infected subjects. Overall, treatments should be the same as in HIV-negative patients with urogenital malignancies. Since the introduction of combination antiretroviral therapy (cART) the outcome appears to have improved due to a decrease in HIV-related deaths. HIV-infected men who are treated with standard therapies for GCC now have a similar cancer-free survival compared with their HIV-negative counterparts. Screening and treatment for prostate cancer should follow recommendations established for HIV-negative men. During radio- or chemotherapy patients should receive concurrent cART but the drug-drug interaction potential must be taken into account.
Sparse data are available with regard to the incidence, clinical characteristics, therapeutic man... more Sparse data are available with regard to the incidence, clinical characteristics, therapeutic management and prognosis of male patients with germ cell tumors, who relapse more than two years after completion of cisplatin-based chemotherapy. A review of 530 patients treated at two institutions from 1978 to April 1994 was conducted. Twenty-five cases of late relapse were identified. Cumulative risk of late relapse was calculated according to the Kaplan-Meier method. 418 of 523 patients (80%) who received their first-line treatment at our institutions were relapse-free at two years. Among these 418 patients 18 cases (4.3%) developed a late relapse. The cumulative risk of late relapse was 1.1% at five years and 4.0% at ten years excluding patients with prior early relapses who carried risks of 9.4% and 29%, respectively (P < 0.0001). No case of late relapse was observed among patients receiving adjuvant chemotherapy. The risk of late relapse was lower in patients with good-risk non-seminomatous germ cell tumors than in poor-risk patients according to Medical Research Council criteria (P < 0.01). Seven further patients were referred from other institutions for treatment of late relapse. At a median follow-up of 38 months (range, 3 to 121) after treatment of late relapse 9 of 25 patients (36%) are continuously disease-free. Six of these nine patients had surgical resection of carcinoma or teratoma as a component of their therapy. The incidence of late relapse after cisplatin-based chemotherapy of germ cell tumors is related to initial tumor burden and is somewhat higher than previously expected. Chemotherapy seems to have only minor curative potential, but localized resectable disease can be cured by surgery. Annual follow-up evaluations allow to detect the majority of late relapses at an asymptomatic stage and should be extended throughout the patient's life.
8046 Background: The high prognostic value of FDG-PET/CT performed after 2 cycles of chemotherapy... more 8046 Background: The high prognostic value of FDG-PET/CT performed after 2 cycles of chemotherapy for HIV negative Hodgkin lymphoma (HL) is well known. However, experience with PET in HIV-related HL needs to be further studied as nodal FDG uptake can be observed in various opportunistic infections and AIDS-related conditions. Methods: A total of 45 consecutive HL patients (pts) were enrolled in 10 centers from the GECAT. There were 42 males and 3 females. Median age was 46 yo, range [26;64]. Median CD4 count was 391/mm3, range [33;1191]. Viral load was negative in 38 pts (84%) and uncontrolled in 5 pts (11%). Forthy three pts (96%) received concomitant HAART. HL was staged III-IV in 25 pts. International Prognostic Index scored 3-5 in 24 pts. All PET studies were performed after 2 ABVD cycles. They were scored, blinded to treatment outcome, according to the 5-point Deauville visual scale. It was considered as negative when scored 1-3 (i.e tumor FDG uptake less or equal than liver uptake) and positive when scored 4-5 (i.e. more than liver uptake or new lesions). Chemotherapy was not modified : 4-8 cycles of ABVD, as initially planned. Results: Overall, 35 pts (78%) achieved a CR after the end of treatment. Three pts received Involved Field Radiation Therapy. At a median follow-up of 18 months, 3 pts relapsed and 2 of them died from HL. The 2 yr OS and PFS were estimated at 94 and 90%, respectively. PET after 2 cycles of ABVD was negative in 40 pts (89%) and positive in 5 pts (11%). Patients with negative PET had a significantly better outcome than those with positive PET in term of 2 yr PFS (94% vs 60%, P=0.005), and 2 yr OS (100% vs 60%, P=0.0002). The negative predictive value was estimated at 97% and specificity at 93%. All patients who were PET-negative after the 2nd cycle stayed PET-negative after the 4th cycle and entered a durable CR. Conclusions: This largest study in HIV-positive HL showed that interim PET could play a central role in driving risk-tailored treatment. In further studies, de-escalation strategies should be tested for patients responding after 2 cycles of ABVD and those not reponding should be managed with intensive salvage strategies.
Non-AIDS-defining malignancies (NADM) are a leading cause of morbidity and mortality for HIV-infe... more Non-AIDS-defining malignancies (NADM) are a leading cause of morbidity and mortality for HIV-infected subjects. The risk of testicular germ cell cancer (GCC) and renal cell cancer is slightly increased in the setting of HIV, whereas there is a slightly decreased risk of prostate cancer and bladder cancer. As in industrialized countries the majority of people living with HIV are men, and people aged 55 and older now account for more than a quarter of persons living with HIV, both testis and prostate cancer are assumed to occur with increased frequency in HIV-infected subjects. Overall, treatments should be the same as in HIV-negative patients with urogenital malignancies. Since the introduction of combination antiretroviral therapy (cART) the outcome appears to have improved due to a decrease in HIV-related deaths. HIV-infected men who are treated with standard therapies for GCC now have a similar cancer-free survival compared with their HIV-negative counterparts. Screening and treatment for prostate cancer should follow recommendations established for HIV-negative men. During radio- or chemotherapy patients should receive concurrent cART but the drug-drug interaction potential must be taken into account.
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