Turning the tide in recurrent NSGCT: Retrospective insights into TIP vs non-TIP salvage chemotherapy.

Abstract

602 Background: Recurrent NSGCT poses a therapeutic challenge and the comparative efficacy data of TIP (Paclitaxel, Ifosfamide and Cisplatin) versus non-TIP regimens is limited. Methods: This retrospective analysis included adult males with recurrent NSGCT treated with second-line salvage chemotherapy (TIP vs non-TIP) between January 2015 and May 2025. Progression-free survival 1 (PFS1) was time from start of therapy to first disease progression or death, while PFS2 was time to progression on second-line therapy or death. Descriptive statistics and Kaplan-Meier analyses were performed. Results: Among 84 patients (median age - 28 years; IQR: 22 – 37 years), 67.9% were from rural areas and 16.7% were self-funded. Smoking and tobacco-chewing were in 14.3% and 27.4%, respectively. Lung metastases were seen in 76.2%. TIP was used in 40 (47.7%) patients (Table 1). Others received triplets like VbIP (11.9%), VIP (10.7%), Gemcitabine-Oxaliplatin-Paclitaxel (2.4%), or doublets like Gem-Ox (15.5%) or Gem-Paclitaxel (11.9%). Twelve (14.3%) lost to follow-up and were excluded from efficacy analysis. At a median follow-up of 87.3 months, median PFS1 was similar between TIP and non-TIP (8.2 vs 7.6 months, p=0.15). TIP showed better median PFS2 (8.2 vs 4.4 months, p=0.015), median OS (33.4 vs 16.9 months, p=0.016) and 5-year OS (43% vs 15%). Toxicity data of 12 (14.3%) patients were missing. Grade > 3 hematological toxicities (78.4% vs 54.3%, p=0.03), pulmonary toxicity (13.5% vs 0%, p=0.024) and febrile neutropenia (43.2% vs 22.9%, p=0.067) were higher with TIP, while hospitalisation rates were similar (18.9% vs 17.1%, p=0.845). Conclusions: TIP improved PFS2 and OS but caused higher hematologic and pulmonary toxicity. Further prospective validation is needed. Baseline demographic characteristics. Characteristics Non-TIP (n = 44) TIP (n = 40) p-value Age group (years) 0.240  < 35 29 (65.9%) 31 (77.5%)  > 35 15 (34.1%) 9 (22.5%) ECOG PS 0.867  0-1 41 (93.2%) 36 (90%)  2 3 (6.8%) 4 (10%) Primary site 0.339  Testicular 30 (68.2%) 30 (75%)  Retroperitoneal 6 (13.6%) 7 (17.5%)  Mediastinal 8 (18.2%) 3 (7.5%) IGCCCG risk stratification 0.052  Good 1 (2.3%) 3 (7.5%)  Intermediate 8 (18.2%) 15 (37.5%)  Poor 35 (79.5%) 22 (55%) Sites of metastases  Non-regional lymph nodes 33 (75%) 30 (75%) 1.0  Lungs 38 (86.4%) 26 (65%) 0.022  Liver 12 (27.3%) 10 (25%) 0.813 Teratomatous component 19 (43.2%) 20 (50%) 0.531 First-line chemotherapy 0.198  BEP (bleomycin, etoposide, cisplatin) 18 (40.9%) 24 (60%)  VIP (etoposide, ifosfamide, cisplatin) 20 (45.5%) 10 (25%)  EP (etoposide, cisplatin) 5 (11.4%) 5 (12.5%)  VbIP (vinblastine, ifosfamide, cisplatin) 0 1 (2.5%)  TIP 1 (2.3%) 0 Testicular surgery  High inguinal orchidectomy (HIO) 25 (56.8%) 28 (70%) 0.211  Scrotal orchidectomy 4 (9.1%) 3 (7.5%) 0.792 Retroperitoneal lymph node dissection (RPLND) 12 (27.3%) 17 (42.5%) 0.143 Metastatectomy 12 (27.3%) 10 (25%) 0.813