Malignant germ cell tumors (GCT) in men infected with the human immunodeficiency virus (HIV): Natural history and results of therapy (Meeting abstract).

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Malignant germ cell tumors (GCT) in men infected with the human immunodeficiency virus (HIV): Natural history and results of therapy (Meeting abstract).

Proc Annu Meet Am Soc Clin Oncol; 13:A4 1994. Unique Identifier : AIDSLINE ICDB/94600001
Timmerman JM; Northfelt DW; Small EJ; Univ. of California, San Francisco, 94143-1270

Abstract: Objectives: To determine how HIV-infected patients (pts) tolerate and respond to treatment for GCT, and how GCT histology and stage compare among HIV+ vs HIV- pts. Methods: 272 pts diagnosed or treated for GCT from 1980 to 1993 were reviewed. 9 new cases among HIV+ men were identified; these were analyzed together with 6 cases previously reported from our institution (Wilkinson, J Urol 140:1157, 1990). Results: Low stage tumors (stages I, IIA) comprised 67% of HIV+ vs 64% of HIV- cases; 67% of HIV+ cases were seminomas vs 50.4% of HIV- cases. All HIV+ pts had Karnofsky performance status of 90% or greater at diagnosis. 7 pts had AIDS at the time of GCT diagnosis, and 5 of 9 pts with pre-treatment CD4 counts had less than 200 CD4 cells. Overall, HIV+ pts tolerated therapy well and there were no treatment-related deaths. 6 pts underwent radiation therapy (XRT) and 2 pts underwent retroperitoneal lymphadenectomy without complications. 7 pts received chemotherapy with 4 cycles of platinum/etoposide/bleomycin (PEB) or platinum/vinblastine/bleomycin (PVB). Complications included 4 episodes of fever/neutropenia in 3 pts, 3 cases of anemia requiring transfusion, and 5 delays or minor dose reductions in chemotherapy due to cytopenias. Of 7 pts treated for advanced disease, there were 5 CRs and 2 PRs. Of 14 patients available for long-term follow-up, there have been 5 deaths (all due to AIDS) at a mean of 27 months after diagnosis of GCT. Of surviving patients, mean follow-up has been 25 months (range 3-47). One recurrence has been treated with local XRT and 4 cycles of PEB to achieve CR. In no case was a pt's HIV disease classification (CDC) changed by anti-tumor therapy. Conclusions: The natural history of GCT is comparable in HIV+ and HIV- men and standard therapy for GCT including orchiectomy, retroperitoneal lymphadenectomy, radiotherapy, and chemotherapy are well tolerated. Despite the associated immunosuppression, concurrent HIV infection should not prohibit standard therapy for GCT.

Keywords: Combined Modality Therapy Follow-Up Studies Human HIV Infections/*PATHOLOGY/THERAPY HIV Seronegativity HIV Seropositivity/PATHOLOGY/THERAPY Male Neoplasm Staging Neoplasms, Germ Cell and Embryonal/*PATHOLOGY/THERAPY Testicular Neoplasms/*PATHOLOGY/THERAPY ABSTRACT
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M9480793

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