TIP Combination Provides 5-Year OS, PFS Benefits for Second-Line GCTs

Paclitaxel, ifosfamide, and cisplatin (TIP) is a combination commonly used for the treatment of germ cell tumors (GCTs), serving as an effective salvage regimen, and it is also used as a second-line treatment for relapsed GCTs.

However, the combination’s long-term outcomes have not been analyzed, and it has not been studied in patients with unfavorable risk factors. A recent trial by Jack Gleeson, MB, BCh, BAO, MRCPI, and colleagues reported updated treatment efficacy and long-term follow-up results of TIP.

A total of 104 patients with GCTs who received TIP after cisplatin-based chemotherapy were included in the study. Favorable response—defined as complete response or partial response with negative tumor markers—was measured along with overall survival (OS) and progression-free survival (PFS) rates, relapse, and toxicity.

A total of 87 patients had favorable risk factors, 17 had at least 1 unfavorable risk factor, and 10 were also treated for a second gonadal primary GCT. The median follow-up was 8.9 years, and the 5-year PFS and OS rates were 66% (95% CI, 55-74) and 69% (95% CI, 59-77), respectively.

Of the patients with favorable risk factors, 69 (79%) achieved favorable response, with 5-year PFS and OS rates of 67% (95% CI, 56-76) and 72% (95% CI, 61-80), respectively. A total of 13 (76%) patients in the unfavorable risk group achieved a favorable response, with 5-year PFS and OS rates of 59% (95% CI, 33-78) and 56% (95% CI, 28-76), respectively.

International Prognostic Factor Study Group reclassification showed that the 5-year PFS and OS rates for patients with intermediate-risk disease or less were 75% (95% CI, 50-89) and 73% (95% CI, 55-85).

TIP can be an effective second-line treatment for patients with GCTs. The upcoming TIGER trial will compare the efficacy of TIP with high-dose chemotherapy to determine the optimal treatment approach.