Therapeutic approaches and outcomes in patients aged 50+ with germ cell tumours.
Authors: Miletic Marija , Aslam Razia , Bunce Catey , Gilson Clare , Mele Teresa , Chakrabarti Deep , Cazzaniga Walter , Raggi Daniele , Adamame Shraddha , Hazell Stephen , Mayer Erik , Sohaib Syed Aslam , Nicol David , Huddart Robert A , Reid Alison Helen 
Published: February 2025

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Background:
Testicular germ cell tumours (GCT) are the most common malignancy in young men, mainly in their 30s. While multimodal treatment leads to excellent survival in younger patients (pts), its incidence is rising in men over 50, who often have comorbidities and higher risks of chemotherapy (ChT) toxicity. Limited data on outcomes in this group highlights the need for more research.
Methods:
We conducted a retrospective single centre study, analysing pts diagnosed with GCT aged 50 years or older between 2014 -2023.
Results:
142 pts were analysed, median age of 57 years (range 50–83). Most pts had an ECOG performance status of 0 (59%), and 26% had ≥ three comorbidities. Seminoma (S) represented 70% of diagnoses, while non-seminoma (NS) 30%. Among NS, embryonal carcinoma (62%) and yolk sac tumor (55%) were the most common. Fifty-six percent had stage I, 42% were above stage I and 2% had an unknown stage. Among stage I pts, 64 had S and 16 had NS. 38 pts (48%) received adjuvant ChT: 29 S treated with carboplatin, 8 NS with BEP, and 1 with EP. Of those given adjuvant ChT, 9 relapsed (24%; 5 S, 4 NS), while 14 on active surveillance relapsed (33%; 12 S, 2 NS). Among metastatic pts, most were classified as IGCCCG good-risk (52%), followed by intermediate (23%) and poor-risk (16%). The most used protocols were EP (32%), BEP (25%), and Carboplatin (20%). Seven stage II seminoma pts received ChT-radiotherapy, with one relapse. The response to first-line treatment was favorable in 78% (n=50) of cases (CR/PR markers negative), while 16% (n=12) had an unfavorable response. The overall 5-year relapse-free survival rate for all pts was 63%, with rates of 70% for Stage I, 79% for Stage II, and 45% for Stage III. The 10-year overall survival rate was 70%, with 80% for Stage I and 59% for advanced stages. At analysis, 78% were alive and 75% in remission. Among those who died, 54% of deaths were due to GCT.
Conclusions:
Our study indicates that survival outcomes for pts with late-onset GCT are considerably less favourable compared to younger cohorts. The data suggests that a higher prevalence of comorbidities, treatment delays, and dose reductions, may contribute to these differences. Moreover, the number of pts relapsing after adjuvant ChT is particularly high and raises the question of whether older age GCT are biologically different. Further research on factors affecting treatment and survival is needed, as a tailored approach could address challenges and improve outcomes.

Treatment delivery and toxicity.

Category
Data

Baseline performance status
0: 58.5%1: 14.8%2: 3.5%3: 0.7%Unknown: 22.5%

Total number of ChT cycles
1-2: 51.8%3-4: 36.1%>4: 12.1%

ChT related toxicity
Grade 3-4: 23.6%Hematological: 15.5%Non-hematological: 19.1%Unknown: 24.5%

ChT delivery
Delays: 11%Dose reduction: 11%

Number of additional hospital admissions
0: 52.7%1: 12.7%2: 4.5%≥3: 5.4%Unknown: 24.7%

Bleomycin delivery
Given: 23.9%Omitted: 76.1%Incidence of pneumonitis: 11.5%