Is There A Role For Short Intensive Therapy Without Stem Cell Support In Relapsed Germ Cell Tumours? A Single Centre Experience Of Gamec Chemotherapy

e15563 Background: Relapsed germ cell tumours remain a continuing clinical problem. The place of high dose chemotherapy with stem cell support at first relapse remains controversial .Recently the publication of prognostic factors (International Prognostic Factors Study Group, IPFSG) has been used to help choose therapy. These depend on response to previous therapy as well as markers and sites involved at relapse. In a previous publication(Shamash et al ,British Journal of Cancer 2007), we found that age ( > 35y) and LDH ( > ULN) were significant with the absence of both being associated with a good outcome. Neither is included in the IPFSG classification. We reviewed the performance of our standard GAMEC regimen ( cisplatin 100mg/m2, high dose methotrexate 8g/m2, actinomycin1mg/m2 and etoposide 360mg/m2 every 14 days with cisplatin on day 8 of cycles 1 and 2) for 3-5 cycles ( 6-10 weeks) , as relapse therapy to see how it performed against the established prognostic factors. Methods: Retrospective review of patients referred for relapsed GCT management. Between 1997 and 2014 , 63 patients were treated with GAMEC at first relapse following failure of cisplatin-based combination chemotherapy. Results: With a median follow up of 80 months the overall 2 y PFS was 57% ( range 42-69) with a 3 y survival of 60% ( 46.2-72).There were 6 treatment related deaths. Fifty-four percent had a normal LDH and were < 35y. According to IPFSG 22% were v.low/low , 56% were intermediate and 21% were high risk . The 2y PFS were 44%, 60% and 22% respectively. Those with normal LDH and < 35y had a 2 y PFS of 79%, those with one or both of these risk factors had a 2 y PFS of 39% and 13%. There was little association between the IPFSG criteria versus age and LDH (Chi2 = 4.85 p = 0.089) Conclusions: Good outcomes are possible using GAMEC in patients < 35y and with normal LDH despite high IPFSG grouping These two factors may be more relevant is deciding whether or not to use this treatment in relapsed germ cell tumours