e16044 Background: Management of metastatic GCT which have relapsed after initial platinum based regimes is challenging. Data showing the efficacy of the TIP regime was published in 2005. We describe our 15 year experience with TIP. Methods: Patients who received ≥ 1 cycle of TIP for relapsed GCT between 1/1/2000 and 1/9/ 2015 were identified. Data was collated on: stage, site, histology, tumour markers, initial treatment, radiological response, relapse free interval, response to TIP, progression free survival (PFS), overall survival (OS), post TIP treatment. Results: Over 2000 patients were treated during this time, 56 patients received TIP. 4 patients were excluded: 1 patient had a previous paediatric sacrococcygeal tumour, 2 patients recieved TIP at another centre, 1 patient had a primary CNS GCT. 52 patients were analysed, their median age was 29 (range 19-55). 49% had a non-seminomatous GCT, 21% had a seminoma, 13% had a mixed GCT, 13% had marker only disease at diagnosis. 91% received 1st line chemotherapy for metastatic disease, 7.5% received adjuvant chemotherapy, data was unavailable for 1 patient. 36% had poor prognosis disease, 11% had intermediate prognosis disease, 38% had good prognosis disease, insufficient data was available for 15%. TIP was commenced a median 5.5 months (range 1-129) after completing initial chemotherapy. 24 patients relapsed ≤ 3 months, 26 patients ≥ 3 months, data was not available in the remainder. 25 patients were alive at the time of analysis, the median OS of the cohort was 24 months. PFS was 9 months (95% 6.1-11.9). Presence of poor prognostic factors as described by Beyer et al, was associated with decreased OS (p = 0.03). Response to TIP was associated with improved survival (p = < 0.005); 76% with complete response, 48% with partial response and 0% with progression were alive 24 months post TIP. In those who relapsed post TIP; 9 received HDCT, 11 had surgical excision, 14 had radiotherapy, 8 had palliative chemotherapy, 7 received supportive care. Conclusions: In our cohort TIP was associated with response rates and OS equivalent to those in published trials. Progression post TIP was associated with poor outcomes demonstrating the need for better treatment options in these patients.

e16046 Background: More than 95% of patients diagnosed with advanced seminoma are cured with chemotherapy - either 3 cycles of bleomycin (B), etoposide (E) and cisplatin (P) or 4 cycles of E-P. Radiotherapy can also be used for low-volume (Stage IIA-B) metastatic disease but may be associated with a higher risk of secondary malignancy. There is increasing emphasis on minimising late treatment toxicity in chemo-curable cancers. The optimal regimen to achieve long-term survival with minimal toxicity in advanced seminoma remains uncertain, in particular the value of bleomycin. Methods: Patients with advanced (Stage IIA and above) pure seminoma treated with etoposide 120mg/m2 days 1,2 and 3 and cisplatin 50mg/m2 day 1 and 2 (EP120) every 3 weeks for 3 cycles between the years 2000 and 2015 were retrospectively identified. Demographics, stage, clinical response, time of relapse, subsequent treatments and overall survival were recorded. Results: 117 patients were identified with a median age of 41years, and 15% were over 50 years. 96% had a testicular primary and 88% had de-novo metastatic disease. 32% had AJCC Stage IIC-IIIC disease. Two patients were in the IGCCC intermediate-risk category with hepatic and intra-gastric metastases. Just over one-third (38%) of patients had an elevated serum β-HCG level. All except one patient achieved a complete biochemical response and all patients had at least a partial radiologic response. At median follow up of 6 years, 96% (112/117) patients have been continuously relapse-free. 1 patient with hepatic metastases was chemo-refractory and died of progressive disease. 4 patients relapsed – all are alive and disease-free at 20, 53, 135 and 68 months from diagnosis. Two relapsing patients received TIP (paclitaxel, ifosphamide, cisplatin) chemotherapy, 1 para-aortic radiotherapy and one had both radiotherapy and TIP. 2 patients died of unrelated causes whilst in complete remission. Conclusions: 3 cycles of EP120 chemotherapy is well-tolerated, feasible and efficacious in advanced seminoma and merits further consideration as standard-of-care in particular in patients with good-risk disease.

Purpose This study analyzed the outcomes of nonrandomized consolidation radiotherapy (RT) given after chemotherapy in the initial treatment of advanced Hodgkin's lymphoma (HL). The results were collected prospectively within a randomized controlled trial of induction chemotherapy. Patients and Methods Patients were randomly assigned between doxorubicin, bleomycin, vinblastine, and dacarbazine and one of two prespecified multidrug regimens. At least six cycles of chemotherapy were planned, with up to eight for patients showing slower response. Involved-field RT was recommended for incomplete response to chemotherapy or bulk disease at presentation. The primary outcome measure was progression-free survival (PFS), landmarked from the end of chemotherapy. Results Among 807 patients randomly assigned, 702 achieved objective response. Postchemotherapy RT for consolidation was reported in 300 (43%). With median follow-up of 6.9 years, 161 PFS events and 83 deaths were reported. Baseline characteristics showed more patients with bulk disease having RT (190 [63%] v 111 [28%]) and only partial response after chemotherapy (150 [50%] v 36 [9%]). Other baseline characteristics were similar. PFS was superior for patients having RT (hazard ratio [HR], 0.43; 95% CI, 0.30 to 0.60) with 5-year PFS 71% without RT, 86% with RT. A similar advantage was seen for overall survival (HR, 0.47; 95% CI, 0.29 to 0.77). There was no evidence of heterogeneity of treatment effect across subgroups. Conclusion Patients who received consolidation RT apparently had better outcomes, consistently across all prognostic groups which persisted in multivariate analysis. This suggests that RT contributes significantly to the cure rate for advanced HL, although patient selection for combined modality treatment requires better definition in prospective trials.

Introduction: This international randomised controlled trial compared ABVD with two multi-drug regimens (MDR) for the initial treatment of advanced Hodgkin Lymphoma (HL). The effects of radiotherapy (RT) given to patients (pts) in complete or partial remission after chemotherapy have been analysed.

We were interested to read the editorial by Dr Carde1, which referred to our article2 that reported the results of the United Kingdom Lymphoma Group LY09 study in advanced Hodgkin's lymphoma. The editorial may have given the impression that our study was a randomized comparison of three regimens, which is not the case. A standard arm of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) was used, and investigators elected in advance whether to randomize against the alternating or hybrid regimen. Thus, it is not legitimate to make direct comparison of the two multidrug arms. It is also difficult to compare the overall results in this study to the Italian trial reported in the same issue by Gobbi et al3, which included a more favorable group of patients among whom only 11% of patients were in International Prognostic Score group 4 to 7, compared with 19% in the UK study. The measure of 65% progression-free survival at 5 years cited by Dr Carde refers only to patients in stages III/IV, whereas for the UK study as a whole the figure is 73%. The interpretation of information regarding the use of radiotherapy in the two parallel randomizations is problematic. Dr Carde suggests that a comparison can be made between the two standard ABVD groups, with the more frequent use of eight cycles in the centers randomizing against alternating treatment apparently giving marginally better freedom from progression results than those seen in the hybrid randomization, where it was more common to use six cycles followed by radiotherapy. Such data must be interpreted with caution, especially because the patients in the hybrid randomization were more likely to have bulky mediastinal disease and systemic symptoms, suggesting a worse prognostic group. We contend that such an effect may be due to patient selection rather than the use of radiotherapy or fewer cycles of ABVD. Finally, Dr Carde has made a provocative analysis of the data, correlating freedom from progression with intended, rather than actual doses delivered. This may be helpful in terms of generating hypotheses to be tested in future studies but does not necessarily explain observed outcomes in the LY09 trial.

Since March 1980, 309 patients with anaplastic small cell carcinoma of the bronchus (ASCB) have received remission induction therapy prior to randomisation to maintenance (M) or no maintenance (NM) chemotherapy. Induction therapy consisted of six courses of vincristine, doxorubicin and cyclophosphamide (VAC) given IV every 3 weeks. Those with limited disease also received mediastinal irradiation. Consenting patients with no unequivocal residual disease were randomised to have no further treatment until relapse or a further eight courses of VAC, at a lower dosage, every 4 weeks. Patients failing to achieve randomisation status received palliative treatment only. The median survival for all patients with limited disease (LD) is 363 days and that for patients with extensive disease (ED) is 272 days (P<0.00001).