Secondary tumours following etoposide containing therapy for germ cell cancer

Background Reports have implied etoposide as the cause of secondary leukaemia in patients treated for germ cell cancer. Patients and methods Between 1979 and 1992, 679 male patients with germ cell cancer received etoposide containing chemotherapy. Results Six of 679 patients developed acute myeloid leukaemia (relative risk 150; CI: 55–326). None of these patients had a primary mediastinal germ cell tumour and only 1 patient received previous radiotherapy. The median interval between the onset of cytotoxic treatment and the development of leukaemia was 27 months. The FAB M4 morphology was seen in 4 of 6 cases. Conclusion The benefit of etoposide containing protocols outweigh the risk of leukaemia in patients with intermediate or high risk disease, however in patients with good risk disease non-etoposide containing protocols should be explored.