First‐line combination chemotherapy with etoposide, ifosfamide and cisplatin for the treatment of disseminated germ cell cancer: Efficacy and feasibility in current clinical practice

2021 ◽  
Author(s):  
Motohiro Fujiwara ◽  
Hajime Tanaka ◽  
Takeshi Yuasa ◽  
Yoshinobu Komai ◽  
Tomohiko Oguchi ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Germ Cell ◽  
Combination Chemotherapy ◽  
Cell Cancer ◽  
Germ Cell Cancer ◽  
Current Clinical Practice ◽  
First Line

Secondary leukemia after first-line high-dose chemotherapy for patients with advanced germ cell cancer

2004 ◽  
Vol 131 (4) ◽  
pp. 255-260 ◽  
Author(s):  
J. Wierecky ◽  
C. Kollmannsberger ◽  
I. Boehlke ◽  
M. Kuczyk ◽  
J. Schleicher ◽  
...  
Keyword(s):  
Germ Cell ◽  
Cell Cancer ◽  
High Dose Chemotherapy ◽  
Germ Cell Cancer ◽  
High Dose ◽  
Secondary Leukemia ◽  
First Line

Management of Advanced Germ Cell Cancer in Patients With Unfavorable Prognosis

2005 ◽  
Vol 3 (1) ◽  
pp. 77-83
Author(s):  
Kim Margolin
Keyword(s):  
Germ Cell ◽  
Cell Cancer ◽  
Germ Cell Cancer ◽  
Phase Iii ◽  
High Dose ◽  
Inadequate Response ◽  
Cell Transplant ◽  
First Line ◽  
Prognostic Features ◽  
Line Therapy

Advanced germ cell cancer can be cured in most patients using chemotherapy with or without surgery. A small fraction of patients with nonseminomatous tumors (NSGCT) and an even smaller percentage of seminoma patients are destined to have a less favorable outcome, due to an inadequate response to first-line chemotherapy (failure to achieve remission, finding of residual viable carcinoma at post-chemotherapy surgery, or relapse after achieving a remission). Despite the apparent salvage potential for regimens containing ifosfamide or paclitaxel, no proof exists that such combinations are superior to the standard regimen of four cycles of cisplatin, etoposide, and bleomycin (PEB) in the front-line therapy of patients with advanced NSGCT. Other modifications of first-line therapy, such as the addition of paclitaxel or the use of escalated doses of cisplatin, also have failed to increase the cure rate. The use of single or tandem cycles of high-dose chemotherapy (HDT with autologous hematopoietic cell transplant [aHCT]) in various settings (for selected patients with poor prognostic features before therapy, patients predicted to have a poor outcome based on the rate of serum tumor marker decline while on therapy, and patients in relapse or failure to achieve adequate response to standard therapy) has been evaluated in many phase II and a limited number of phase III trials, which are summarized in this review. Important questions that remain to be answered include the role of new agents and the use of more sophisticated techniques to understand prognostic and predictive factors in selecting therapy for GCT.

scholarly journals First-line high-dose chemotherapy ± radiation therapy in patients with metastatic germ-cell cancer and brain metastases

2000 ◽  
Vol 11 (5) ◽  
pp. 553-560 ◽  
Author(s):  
C. Kollmannsberger ◽  
C. Nichols ◽  
M. Bamberg ◽  
J.T. Hartmann ◽  
N. Schleucher ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Brain Metastases ◽  
Germ Cell ◽  
Cell Cancer ◽  
High Dose Chemotherapy ◽  
Germ Cell Cancer ◽  
High Dose ◽  
First Line

Management of Refractory Germ Cell Cancer

2018 ◽  
pp. 324-329 ◽  
Author(s):  
Anja Lorch
Keyword(s):  
Prognostic Factors ◽  
Germ Cell ◽  
Cell Cancer ◽  
High Dose Chemotherapy ◽  
Tumor Burden ◽  
Germ Cell Cancer ◽  
Salvage Treatment ◽  
High Dose ◽  
First Line ◽  
Conventional Dose

Over the past 5 decades, the use of well-validated, guideline-based strategies has resulted in high cure rates in newly diagnosed patients with germ cell cancer. However, about 30% of those with metastatic disease at initial presentation will experience refractory disease. Salvage treatment is far more complex and less validated than first-line treatment because it is rare, patient cohorts are more heterogeneous, and prognostic factors seem to have greater impact. Prior to the initiation of any salvage treatment, several considerations must be made, including assessment of known prognostic factors and choice of the optimal salvage strategy. Evaluation of patients according to their disease biology, response to prior treatment, and the extent of their tumor burden at the time of salvage treatment is crucial for establishing the optimal salvage strategy. Patients with metastatic germ cell cancer in whom adequate cisplatin-based first-line chemotherapy fails should be included in the ongoing randomized TIGER trial comparing conventional-dose chemotherapy with high-dose chemotherapy as first salvage treatment. Outside this trial, patients may be treated with conventional or high-dose chemotherapy depending on the presence or absence of adverse prognostic factors, availability of resources, and patient and physician preferences.

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