Salvage chemotherapy with gemcitabine plus oxaliplatin for patients with testicular germ cell cancer

Background The purpose of this study is to assess the feasibility of salvage chemotherapy with gemcitabine and oxaliplatin (GEMOX) for Japanese patients with refractory testicular germ cell cancer. Methods Eleven patients were treated with GEMOX. All had experienced disease progression or recurrence and had been treated with the standard induction chemotherapy and at least one cycle of cisplatin-based salvage chemotherapy (median 6 cycles) before the start of GEMOX. GEMOX consisted of gemcitabine 1,000 mg/m 2 intravenously on days 1 and 8 and oxaliplatin 130 mg/m 2 on day 1. Results Two patients (18 %) achieved a complete response (CR) after GEMOX and surgical resection of residual tumor. One additional patient responded to GEMOX, but was forced to discontinue treatment due to sensory neuropathy. This patient achieved CR after further treatment with irinotecan-based chemotherapy and surgery. All three patients have remained continuously free from disease progression at a median follow-up duration of 24 months. Sixty-four per cent of patients developed grade 3 leukocytopenia and 82 % developed grade 3 or higher thrombocytopenia but they were all managed with routine supportive care. Sensory neuropathy was frequently seen but no patient experienced neurotoxicity higher than grade 3. Conclusions GEMOX as salvage chemotherapy is tolerable for intensively pretreated Japanese patients. GEMOX may offer a chance of long-term disease-free status even after failure of multiple cycles of chemotherapy.