scholarly journals Long term survival of patients with recurrent or refractory germ cell tumors after high dose chemotherapy

Cancer ◽  
1997 ◽  
Vol 79 (1) ◽  
pp. 161-168 ◽  
Author(s):  
J�rg Beyer ◽  
Dorothea Kingreen ◽  
Manuela Krause ◽  
Jan Schleicher ◽  
Ingo Schwaner ◽  
...  
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumors ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Term Survival ◽  
Long Term Survival

Sequential Versus Single High-Dose Chemotherapy in Patients With Relapsed or Refractory Germ Cell Tumors: Long-Term Results of a Prospective Randomized Trial

2012 ◽  
Vol 30 (8) ◽  
pp. 800-805 ◽  
Author(s):  
Anja Lorch ◽  
Antje Kleinhans ◽  
Andrew Kramar ◽  
Christian K. Kollmannsberger ◽  
Jörg T. Hartmann ◽  
...  
Keyword(s):  
Germ Cell ◽  
Survival Rates ◽  
Germ Cell Tumors ◽  
High Dose Chemotherapy ◽  
Long Term Results ◽  
Rank Test ◽  
High Dose ◽  
Term Survival ◽  
Long Term Survival

Purpose To evaluate the long-term survival rates in patients with relapsed or refractory germ cell tumors (GCTs) after single or sequential high-dose chemotherapy (HDCT). Patients and Methods Between November 1999 and November 2004, 211 patients with relapsed or refractory GCT were randomly assigned to treatment with either one cycle of cisplatin 100 mg/m2, etoposide 375 mg/m2, and ifosfamide 6 g/m2 (VIP) plus three cycles of high-dose carboplatin 1,500 mg/m2 and etoposide 1,500 mg/m2 (CE, arm A) or three cycles of VIP plus one cycle of high-dose carboplatin 2,200 mg/m2, etoposide 1,800 mg/m2, and cyclophosphamide 6,400 mg/m2 (CEC, arm B) followed by autologous stem-cell reinfusion. Long-term progression-free survival (PFS) and overall survival (OS) 6 years after random assignment of the last patient were compared by using the log-rank test. Results Overall, 108 and 103 patients were randomly assigned to arms A and B, respectivelyl. The study was stopped prematurely because of excess treatment-related mortality in arm B (14%) compared with that in arm A (4%; P = .01). As of December 2010, nine (5%) of 211 patients were lost to follow-up; 94 (45%) of 211 are alive and 88 (94%) of 94 patients are progression free. Five-year PFS is 47% (95% CI, 37% to 56%) in arm A and 45% (95% CI, 35% to 55%) in arm B (hazard ratio [HR], 1.16; 95% CI, 0.79 to 1.70; P = .454). Five-year OS is 49% (95% CI, 40% to 59%) in arm A and 39% (95% CI, 30% to 49%) in arm B (HR, 1.42; 95% CI, 0.99 to 2.05; P = .057). Conclusion Patients with relapsed or refractory GCT achieve durable long-term survival after single as well as sequential HDCT. Fewer early deaths related to toxicity translated into superior long-term OS after sequential HDCT.

Results of Treatment After Relapse From High-Dose Chemotherapy in Germ Cell Tumors

2000 ◽  
Vol 18 (6) ◽  
pp. 1181-1186 ◽  
Author(s):  
Pierluigi Porcu ◽  
Sumeet Bhatia ◽  
Matt Sharma ◽  
Lawrence H. Einhorn
Keyword(s):  
Germ Cell ◽  
Response Rate ◽  
Objective Response ◽  
Germ Cell Tumors ◽  
High Dose Chemotherapy ◽  
Salvage Treatment ◽  
High Dose ◽  
Term Survival ◽  
Platinum Based Chemotherapy

PURPOSE: To identify therapy-related or patient-related characteristics that predict response and long-term survival after failure of high-dose chemotherapy (HDCT) for germ cell tumors (GCT). PATIENTS AND METHODS: Between 1986 and 1997, 101 GCT patients relapsed after high-dose carboplatin and etoposide (VP-16) at Indiana University (Indianapolis, IN). Median time to relapse was 10 months (range, 1 to 17 months). HDCT was the first salvage treatment in 29 patients and second or later salvage treatment in 72 patients. RESULTS: Fifty-four of 101 patients received post-HDCT treatment. Of these, 47 received chemotherapy, alone (n = 35) or in combination with surgery (n = 12). Seven patients underwent surgery alone. There were only 12 objective responses (three complete and nine partial responses) for 66 chemotherapy regimens given to 47 patients, for an overall response rate of 18.2%. Fifteen patients received platinum-based chemotherapy, with only one objective response. Chemotherapy was discontinued in 17% of cases because of toxicity. A longer interval between HDCT and post-HDCT treatment was the only variable that was associated with response. Five patients (4.9%) are disease-free at 30, 53, 57, 85, and 93 months after relapse. Of these, three responded to oral VP-16 and underwent resection of residual mediastinal, retroperitoneal, and inguinal cancer, respectively. One had resection of residual mediastinal yolk sac tumor, followed by oral VP-16. One relapsed with teratoma and received thoracoabdominal resection without chemotherapy. CONCLUSION: Patients who experience disease progression after HDCT often receive further chemotherapy and/or surgery. Chemotherapy resulted in a response rate of less than 20%, with only three complete responses. All of the long-term survivors (4.9%) had surgery as a component of their post-HDCT regimen.

Long-term survival and late toxicities after high-dose chemotherapy in patients suffering from germ cell cancer

1997 ◽  
Vol 33 ◽  
pp. S37-S38
Author(s):  
O. Rick ◽  
J. Beyer ◽  
N. Schwella ◽  
D. Kingreen ◽  
A. Krusch ◽  
...  
Keyword(s):  
Germ Cell ◽  
Cell Cancer ◽  
High Dose Chemotherapy ◽  
Germ Cell Cancer ◽  
High Dose ◽  
Term Survival ◽  
Long Term Survival

Combination Chemotherapy With Gemcitabine Plus Oxaliplatin in Patients With Intensively Pretreated or Refractory Germ Cell Cancer: A Study of the German Testicular Cancer Study Group

2004 ◽  
Vol 22 (1) ◽  
pp. 108-114 ◽  
Author(s):  
C. Kollmannsberger ◽  
J. Beyer ◽  
R. Liersch ◽  
P. Schoeffski ◽  
B. Metzner ◽  
...  
Keyword(s):  
Germ Cell ◽  
Partial Remission ◽  
Cell Cancer ◽  
Single Agent ◽  
High Dose Chemotherapy ◽  
Germ Cell Cancer ◽  
High Dose ◽  
Term Survival ◽  
Long Term Survival

Purpose Long-term survival is rarely achieved in patients with cisplatin-refractory germ cell cancer (GCT). Both single-agent gemcitabine and oxaliplatin have shown activity in patients who experience relapse or are refractory to cisplatin treatment. This study investigates the activity of a gemcitabine plus oxaliplatin regimen in these patients. Patients and Methods Gemcitabine was administered at a dose of 1,000 mg/m2 on days 1 and 8; oxaliplatin was administered at a dose of 130 mg/m2 on day 1. Response was evaluated every 4 weeks. Results Thirty-five patients with a median age of 37 years (range, 21 to 54 years) were enrolled onto the study. Primary tumor localization was gonadal, retroperitoneal, or mediastinal in 30, one, and four patients, respectively. Patients had been pretreated with a median of six platinum-containing cycles (range, four to 13 cycles) and 89% of patients previously had experienced treatment failure after high-dose chemotherapy with peripheral-blood stem-cell transplantation. Sixty-three percent of patients were considered absolutely cisplatin-refractory or cisplatin-refractory. A median of two cycles (range, 1 to 6 cycles) per patient were applied. Toxicity consisted mainly of myelosuppression, with Common Toxicity Criteria grade 3 occurring in 54% of patients. Only 9% of patients developed neutropenic fever. Three patients attained a complete remission (CR), two patients attained a marker-negative partial remission, and 11 patients attained a marker-positive partial remission, resulting in an overall response rate of 46% (95% CI, 30% to 64%). All three patients with CR and one patient with a marker-negative partial remission remained disease free at 16+, 12+, 4+, and 2+ months of follow-up. Seven (44%) of these 16 responses, including one CR, occurred in cisplatin-refractory patients. Conclusion Gemcitabine plus oxaliplatin demonstrates antitumor activity with acceptable toxicity in heavily pretreated patients with relapsed or cisplatin-refractory GCT, and may offer a chance of long-term survival for selected patients.

Long-Term Survival After High-Dose Salvage Chemotherapy for Germ Cell Malignancies With Adverse Prognostic Variables

2003 ◽  
Vol 21 (22) ◽  
pp. 4100-4104 ◽  
Author(s):  
Daniel A. Vaena ◽  
Rafat Abonour ◽  
Lawrence H. Einhorn
Keyword(s):  
Germ Cell ◽  
Poor Prognosis ◽  
Germ Cell Tumors ◽  
High Dose Chemotherapy ◽  
Salvage Chemotherapy ◽  
High Dose ◽  
Prognostic Variables ◽  
Term Survival ◽  
Risk Patients ◽  
Platinum Refractory

Purpose: Independent prognostic variables for patients undergoing high-dose chemotherapy (HDCT) as salvage modality for germ cell tumors (GCT) were previously described, and a score was created. Patients with more than 2 points had a poor prognosis. However, these data were from patients treated from 1984 to 1993, and most received a single HDCT course. In this study, we evaluated outcomes at Indiana University and determined the applicability of the Beyer score to contemporary poor-risk patients. Patients and Methods: We performed a retrospective analysis of patients who received salvage HDCT between 1988 and 2001 and had at least one of the following characteristics: platinum-refractory or absolutely platinum-refractory GCT, primary mediastinal nonseminomatous GCT (PMNSGCT), human chorionic gonadotropin (HCG) ≥ 1,000 mU/mL or alpha-fetoprotein (AFP) ≥ 1,000 ng/mL before HDCT. Primary end points were overall and 2-year failure-free survival (FFS). Results: Eighty patients were identified. Fifty-six were platinum refractory, 23 had a Beyer score greater than 2, and 13 had PMNSGCT. Fifty-six patients received two HDCT courses. HDCT included carboplatin and etoposide. Forty-three patients received HDCT as first salvage modality. Median overall survival was 14.7 months. The 2-year FFS was 32%. No relapses have occurred after 2 years from HDCT. Patients with greater than 2 points in the Beyer score, platinum-refractory patients, and patients with HCG ≥ 1,000 mU/mL, AFP ≥ 1,000 ng/mL, and PMNSGCT had 2-year FFS of 30%, 37%, 26%, 18%, and 0%, respectively. Conclusion: Results with PMNSGCT remained poor. However, other patients with poor prognosis should not be denied an attempt at curative salvage HDCT.

Long-Term Survival After Treatment with Gemcitabine and Oxaliplatin With and Without Paclitaxel Plus Secondary Surgery in Patients with Cisplatin-Refractory and/or Multiply Relapsed Germ Cell Tumors

2011 ◽  
Vol 60 (4) ◽  
pp. 850-855 ◽  
Author(s):  
Karin Oechsle ◽  
Christian Kollmannsberger ◽  
Friedemann Honecker ◽  
Frank Mayer ◽  
Cornelius F. Waller ◽  
...  
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumors ◽  
Secondary Surgery ◽  
Term Survival ◽  
Long Term Survival
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