Modified cisplatin, etoposide, and ifosfamide (PEI) salvage therapy for male germ cell tumors: Long-term efficacy and safety outcomes

A. Necchi, N. Nicolai, L. Mariani, D. Raggi, E. Farè, P. Giannatempo, M. Catanzaro, D. Biasoni, T. Torelli, S. Stagni, A. Milani, L. Piva, G. Pizzocaro, A. M. Gianni, R. Salvioni

Research output: Contribution to journalArticlepeer-review


Background: Since 1985, we introduced a modified combination of etoposide, ifosfamide, and cisplatin (PEI) as second-line therapy of adult male germ cell tumors with the aim to reduce toxic effect while maintaining efficacy over the original regimen. Patients and Methods: Patients received four cycles of ifosfamide at 2.5 g/m2 on days 1-2, etoposide, and cisplatin at 100 and 33 mg/m2, respectively, on days 3-5 every 21 days, followed by surgery. Results were stratified according to the International Germ Cell Consensus Classification Group-2 (IGCCCG-2). Results: From February 1985 to January 2012, 189 patients were treated. 72.6% were IGCCCG-2 intermediate-to-very high risk. Thirty-five patients (18.5%) had a complete response, 67 (35.4%) a marker normalization (PRm-). Median follow-up was 122.1 months (inter-quartile range [IQR]: 71.4-232.0). Two-year progression-free and 5-year overall survival were 34.3% [95% confidence interval (CI) 28.1% to 41.9%] and 42.1% (95% CI 35.3% to 50.2%), respectively. Survival estimates compared favorably with those obtained by conventional dose chemotherapy (CDCT) regimens in each prognostic category. 70.4% of grade 3-4 neutropenia (25.5% febrile neutropenia), 48.1% thrombocytopenia, 21.2% anemia, 3.2% neurotoxic effect, and no severe renal toxic effect were recorded. Conclusion: Dose-modified Italian PEI should be considered as an appropriate benchmark for CDCT in the first salvage setting.

Original languageEnglish
Article numbermdt271
Pages (from-to)2887-2892
Number of pages6
JournalAnnals of Oncology
Issue number11
Publication statusPublished - Nov 2013


  • Combination chemotherapy
  • Salvage therapies
  • Testicular neoplasms

ASJC Scopus subject areas

  • Oncology
  • Hematology


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