@article{3077879,
    title = "Outcome of men with relapses after adjuvant bleomycin, etoposide, and cisplatin for clinical stage I nonseminoma",
    author = "Fischer, S. and Tandstad, T. and Cohn-Cedermark, G. and Thibault, C. and Vincenzi, B. and Klingbiel, D. and Albany, C. and Necchi, A. and Terbuch, A. and Lorch, A. and Aparicio, J. and Heidenreich, A. and Hentrich, M. and Wheater, M. and Langberg, C.W. and Ståhl, O. and Fankhauser, C.D. and Hamid, A.A. and Koutsoukos, K. and Shamash, J. and White, J. and Bokemeyer, C. and Beyer, J. and Gillessen, S.",
    journal = "Journal of Clinical Oncology",
    year = "2020",
    volume = "38",
    number = "12",
    pages = "1322-1331",
    publisher = "American Society of Clinical Oncology",
    issn = "0732-183X, 1527-7755",
    doi = "10.1200/JCO.19.01876",
    keywords = "bleomycin;  carboplatin;  cisplatin;  etoposide;  ifosfamide;  paclitaxel;  antineoplastic agent;  bleomycin;  cisplatin;  etoposide, adjuvant therapy;  adult;  Article;  cancer chemotherapy;  cancer specific survival;  cancer surgery;  cause of death;  clinical stage i nonseminoma;  disease exacerbation;  disease free survival;  follow up;  human;  major clinical study;  male;  oligodendroglioma;  outcome assessment;  overall survival;  priority journal;  progression free survival;  relapse;  retrospective study;  teratoma;  testis tumor;  adjuvant chemotherapy;  cancer staging;  clinical trial;  multicenter study;  neoplasm;  orchiectomy;  pathology;  survival rate;  testis tumor;  treatment outcome, Adult;  Antineoplastic Combined Chemotherapy Protocols;  Bleomycin;  Chemotherapy, Adjuvant;  Cisplatin;  Etoposide;  Humans;  Male;  Neoplasm Staging;  Neoplasms, Germ Cell and Embryonal;  Orchiectomy;  Progression-Free Survival;  Retrospective Studies;  Survival Rate;  Testicular Neoplasms;  Treatment Outcome",
    abstract = "PURPOSE Clinical stage I (CSI) nonseminoma (NS) is a disease limited to the testis without metastases. One treatment strategy after orchiectomy is adjuvant chemotherapy. Little is known about the outcome of patients who experience relapse after such treatment. PATIENTS AND METHODS Data from 51 patients with CSI NS who experienced a relapse after adjuvant bleomycin, etoposide, and cisplatin (BEP) from 18 centers/11 countries were collected and retrospectively analyzed. Primary outcomes were overall and progression-free survivals calculated from day 1 of treatment at first relapse. Secondary outcomes were time to, stage at, and treatment of relapse and rate of subsequent relapses. RESULTS Median time to relapse was 13 months, with the earliest relapse 2 months after start of adjuvant treatment and the latest after 25 years. With a median follow-up of 96 months, the 5-year PFS was 67% (95% CI, 54% to 82%) and the 5-year OS was 81% (95% CI, 70% to 94%). Overall, 19 (37%) of 51 relapses occurred later than 2 years. Late relapses were associated with a significantly higher risk of death from NS (hazard ratio, 1.10 per year; P = .01). Treatment upon relapse was diverse: the majority of patients received a combination of chemotherapy and surgery. Twenty-nine percent of patients experienced a subsequent relapse. At last followup, 41 patients (80%) were alive and disease-free, eight (16%) had died of progressive disease, and one patient (2%) each had died from therapy-related or other causes. CONCLUSION Outcomes of patients with relapse after adjuvant BEP seem better compared with patients who experience relapse after treatment of metastatic disease but worse compared with those who have de-novo metastatic disease. We found a substantial rate of late and subsequent relapses. There seem to be three patterns of relapse with different outcomes: pure teratoma, early viable NS relapse (, 2 years), and late viable NS relapse (. 2 years). © 2019 by American Society of Clinical Oncology"
}