Ülkü Yalçintaş ARSLAN, Ercan ARPACI, Saadet TOKLUOĞLU, Ayşe DURNALI, Nazan GÖKBAYRAK, Necati ALKIŞ

Gemcitabine PlusPaclitaxel STherapy in a Patient vvith Relapsed Testicular Cancer After High Dose Therapy

Metastatik testis tümörlerinin oldukça büyük bir kısmı platin temelli tedavi ile iyileşir. Sisplatin dirençli yada yüksek doz tedavi uygulamaları sonrası nükseden olguların prognozu oldukça kötüdür. Bu olgu sunumunda 25 yaşında metastatik testis embriyona! karsinoma tanısı alan bir erkek hasta bildirilmiştir. Birinci basamak tedavi olarak bleomisin, etoposid, sisplatin (BEP) kemoterapi rejimi uygulanan hasta beyin metastazı ile nüksetti ve ikinci sıra vinblastin, ifosfamid, sisplatin (VeİP) tedavisi sonrası yüksek doz kemoterapi ve periferik kök hücre nakli uygulandı. Sonrasında nüks hastalık gelişen olguya kurtarma tedavisi olarak gemsitabin, paklitaksel kombinasyonu verildi. Olgu 30. ayda halen remisyonda izlenmektedir.

Anahtar Kelimeler:

Testis kanseri, gemsitabin, paklitaksel, kurtarma tedavisi.

Yüksek Doz Tedavi Sonrasında Nükseden Testis Kanserli Bir Hastada Gemsitabin ve Paklitaksel Kurtarma Tedavisi

The majority of patients vvith metastatic non-seminomatous germ celi tumors can be cured by cisplatin based combination chemotherapy. Hovvever, patients vvhose condition is cisptatin-refractory or who have recurrence after high dose chemotherapy have vvorse prognosis. We presented here, a 25 years old male patients was diagnosed metastatic embriyonaI testicular carcinoma. The patients received bleomycin, etoposide, cisplatin (BEP) regimen as first line chemotherapy. He experienced early brain relaps and as second line chemotherapy vinblastine, ifosfamide, cisplatin (VeİP) therapy was used. He undervvent high dose chemotherapy vvith peripheric stem celi rescue. For the patient experienced a second recurrence, gemcitabine and pacli-taxel was administered as salvage chemotherapy. He is alive and is free from disease at 30 months.

Keywords:

Testicular cancer, gemcitabine, paclitaxel, salvage treatment.,

PDF

___

Holmes L, Escalarıte C, Garrisorı O, et al. Testicular cancer incidence trends in the United States (1975-2004): Piateau or shifting racial paradigm? Public Health 2008;122:862-72.
Bosl GJ, Bajorin DF, Sheinfeld J, MotzerRJ, Chaganti RSK. Cancer of the testis. İn: DeVita VT, Lawrence TS, Rosenberg SA (eds). Cancer, Principles and Practice of Oncology. 8th ed. Philadelphia: Lippincott-Raven,2008:1463-86.
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;357:340-8.
Kawai K, Miyazaki J, Tsukamoto S, et al. Paclitaxel, Ifosfamide and cisplatin regimen is feasible for Japanese patients with advanced germ celi cancer. Jpn J d in Oncol 2003;33:127-31.
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 celi tumors. J d in Oncol 2005;23:6549-55.
Loehrer P, Gonin R, Nichols C, et al. Vinblastine plus ifosfa mide plus cisplatin as initial salvage therapy in recurrent germ celi tu mor. J d in Oncol 1998;16:2500-4.
McCaffrey JA, Mazumdar M, Bajorin DF, et al. ifosfamide- and cisplatin-containing chemotherapy as first-line salvage therapy in germ celi tumors: Response and survival. J Clin Oncol 1997;15:2559-63.
Kollmannsberger C, Rick O, Derigs HG, et al. Activity of oxaliplatin in patients with relapsed or cisplatin-refractory germ celi cancer: A study of the German Testicular Cancer Study Group. J Clin Oncol 2002;20:2031-7.
Einhorn LH, Stender MJ, VVİlliams SD, et al. Phase II Trial of gemcitabine in refractory germ celi tumors. J Clin Oncol 1999;17:509-11.
Bokemeyer C, Geri A, Schöffski P, et al. Gemcitabine in pati ents with relapsed or cisplatin-refractory testicular cancer. J Clin Oncol 1999;17:512-6.
Sandler AB, Cristou A, Fox S, et al. A Phase II trial of pacli- taxel in refractory germ celi tumors. Cancer 1998;82:1381-6.
Bokemeyer C, Beyer J, Metzner B, et al. Phase II study of paclitaxel in patients with relapsed or cisplatin-refractory testicular cancer. Ann Oncol 1996;7:31-4.
De Giorgi U, Rosti G, Aieta M, et al. Phase II study of oxa- liplatin and gemcitabine salvage chemotherapy in patients with cisplatin-refractory nonseminomatous germ celi tumor. Eur Urol 2006;50:1032-8.
Theodore C, Chevreau C, Yataçhene Y, et al. A phase II mul- ticenter study of oxaliplatin in combination with paclitaxel in poor prognosis patients who failed cisplatin-based chemot herapy for germ-cell tumors. Ann Oncol 2008;19:1465-9.
Hinton S, Catalano P, Einhorn LH, et al. Phase II study of paclitaxel plus gemcitabine in refractory germ celi tumors (E9897): A Trial of the Eastern Cooperative Oncology Group. J Clin Oncol 2002;20:1859-63.
Einhorn LH, Brames MJ, Juliar B, et al. Phase II study of paclitaxel plus gemcitabine salvage chemotherapy for germ celi tumors after progression follovving high-dose chemothe rapy with tandem transplant. J Clin Oncol 2007;25:513-6.