Conventional-Dose Versus High-Dose Chemotherapy As First Salvage Treatment in Male Patients With Metastatic Germ Cell Tumors: Evidence From a Large International Database

2011 ◽  
Vol 29 (16) ◽  
pp. 2178-2184 ◽  
Author(s):  
Anja Lorch ◽  
Caroline Bascoul-Mollevi ◽  
Andrew Kramar ◽  
Lawrence Einhorn ◽  
Andrea Necchi ◽  
...  
Keyword(s):  
Germ Cell ◽  
Cox Model ◽  
Germ Cell Tumors ◽  
High Dose Chemotherapy ◽  
Salvage Treatment ◽  
Hazard Ratio ◽  
Treatment Modalities ◽  
High Dose ◽  
Conventional Dose ◽  
Male Patients

Purpose Conventional-dose chemotherapy (CDCT) and high-dose chemotherapy (HDCT) may both be successfully used as salvage treatment for patients with metastatic germ cell tumors (GCTs) who experience progression with first-line treatment. Patients and Methods Data on 1,984 patients with GCTs who experienced progression after at least three cisplatin-based cycles and were treated with either cisplatin-based CDCT or carboplatin-based HDCT chemotherapy were collected from 38 centers or groups worldwide. Of 1,984 patients, 1,594 (80%) were eligible, and among the eligible patients, 1,435 (90%) could reliably be classified into one of the following five prognostic categories based on prior prognostic classification: very low (n = 76), low (n = 257), intermediate (n = 646), high (n = 351), and very high risk (n = 105). Within each of the five categories, the progression-free survival (PFS) and overall survival (OS) after CDCT and HDCT were compared using the Cox model adjusted for significant distributional differences between important variables. Results Overall, 773 patients received CDCT, and 821 patients received HDCT. Both treatment modalities were used with similar frequencies within each prognostic category. The hazard ratio for PFS was 0.44 (95% CI, 0.39 to 0.51) stratified on prognostic category, and the hazard ratio for OS was 0.65 (95% CI, 0.56 to 0.75), favoring HDCT. These results were consistent within each prognostic category except among low-risk patients, for whom similar OS was observed between the two treatment groups. Conclusion This retrospective analysis suggests a benefit from HDCT given as intensification of first salvage treatment in male patients with GCTs and emphasizes the need for another prospective randomized trial comparing CDCT to HDCT in this patient population.

High-dose chemotherapy (HDCT) as second salvage treatment in patients with multiple relapsed or refractory germ cell tumors

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5082-5082
Author(s):  
J. Beyer ◽  
M. Hackenthal ◽  
A. Lorch ◽  
A. Neubauer ◽  
A. Dieing ◽  
...  
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumors ◽  
Median Number ◽  
High Dose Chemotherapy ◽  
Salvage Chemotherapy ◽  
Salvage Treatment ◽  
Additional Patient ◽  
High Dose ◽  
First Line ◽  
Conventional Dose

5082 Background: To determine the activity of high-dose chemotherapy (HDCT) as intensification of second salvage treatment (SST) in patients with multiple relapsed germ-cell tumors (GCT). Methods: Databases in Berlin and Marburg (Germany) on patients treated with HDCT between 1989 and 2008 for germ-cell tumors were screened. Among 534 patients overall, 71/534 (13%) patients were identified as scheduled for HDCT having failed at least one previous conventional-dose first-line and first-salvage chemotherapy regimen. Forty-nine patients who had received at least cisplatin- and etoposide as first-line as well as conventional-dose cisplatin as first-salvage treatment and were diagnosed after January 1, 1990, were further analyzed. Results: Median age at SST was 32 years (range 19 to 52 years). Median follow-up for surviving patients was 4 years (range 1,7 to 8,5 years). Histology was pure seminoma in 5/49 (10%) patients and non-seminoma or mixed histologies in 44/49 (90%). The median number of cisplatin-based treatment cycles prior to SST was 7 (range 5 to 11 cycles). Three of forty-nine (6%) patients either progressed or died prior to scheduled HDCT, the remaining 46/49 (94%) received either single or sequential HDCT. The rate of favorable responses to HDCT as intensification of SST was 27/49 (55%). Ten patients are alive without progression. One additional patient is lost-to-follow at four years without progression. The projected overall survival rate at five years after initiation of SST was 17%. Conclusions: HDCT can induce long term remissions even in patients with multiple relapsed GCT. No significant financial relationships to disclose.

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.

Individual Treatment with Stem Cell Rescue in Patients with Germ-Cell Tumors. Results of One Centrum.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5429-5429
Author(s):  
Jana Nepomucka ◽  
Jitka Abrahamova ◽  
Martin Foldyna ◽  
Zuzana Donatova ◽  
Drahomira Kordikova ◽  
...  
Keyword(s):  
Stem Cell ◽  
Germ Cell ◽  
Germ Cell Tumors ◽  
High Dose Chemotherapy ◽  
Salvage Treatment ◽  
Individual Treatment ◽  
High Dose ◽  
Line Treatment ◽  
Stem Cell Rescue ◽  
The Individual

Abstract Background: Treatment with high dose chemotherapy and autologous stem cell rescue in pacients with poor risk germ cell tumors is still controversial. Results of multicentric randomized EBMT study IT 94 presented at ASCO 2002 show benefit in 1-year EFS in high dose arm (52% versus 48%), 3-year EFS was the same in both arms (53%) in salvage treatment. Individual treatment with stem cell rescue as upfront treatment offers a survival benefit. Methods:Autologous stem cell rescue was provided in our center, from September 1997 to May 2006 to 52 patients. High dose chemotherapy was indicated to 32 patients in salvage setting after 2nd line of treatment (VeIP) and to 20 patients as upfront treatment after 1st line treatment (BEP). Median age was 29 years and tumor markers were elevated: HCG in 9 pts, AFP in 13 pts. Stem cell mobilization was performed after the 3rd cycle of VeIP or BEP in combination with G-CSF. The amount of CD34+ cell/kg b.w. was between 2,0 – 13.4×106. High - dose conditioning regimen CARBOPEC (carboplatin 1600 – 2 200 mg/m2, etoposide 1 800mg/m2, cyclophosphamide 6 400 mg/m2) was used. The treatment was well tolerated without transplant - related mortality. Results: WHO criteria non - hematological toxicity was predominantly grade 2 to 3. Engraftment was rapid, recovery of hematopoiesis in neutrofils over 1.0×109/l and platelets over 50×109/l was reached an average on days +10 and +13 respectively. Additional post-transplant treatment for persistence, progression or relaps had 20 patients (8pts had 2nd line treatment VEIP, 12pts had 3nd line treatment with paclitaxel+gemcitabine and 5 pts had retroperitoneal lymfadenectomy). The follow - up period ranges from 3 to 99 months, at present 38 (73 %) patients are alive, 14 (27 %) pts died. Median TTP of all pts is 10 months, median OS of all pts is 39 months. Median DFS of surviving pts is 38 months. Conclusion: high-dose chemotherapy with autologous stem cell rescue in patients with poor risk germ cell tumors is feasible and beneficial method of the individual treatment. High-dose chemotherapy as upfront treatment for poor prognosis germ cell tumors and as salvage treatment in good risk pts seems to be good possibility of the individual treatment.

IMPORTANCE OF SURGERY AS SALVAGE TREATMENT AFTER HIGH DOSE CHEMOTHERAPY FAILURE IN GERM CELL TUMORS

2001 ◽  
Vol 165 (6 Part 1) ◽  
pp. 1920-1926 ◽  
Author(s):  
AUDE FLÉCHON ◽  
MICHEL RIVOIRE ◽  
PIERRE BIRON ◽  
JEAN-PIERRE DROZ
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumors ◽  
High Dose Chemotherapy ◽  
Salvage Treatment ◽  
High Dose

scholarly journals Comparison of three or fewer high-dose chemotherapy cycles as salvage treatment in germ cell tumors in first relapse

2016 ◽  
Vol 52 (2) ◽  
pp. 334-336 ◽  
Author(s):  
F Gössi ◽  
M Spahn ◽  
M Zweifel ◽  
S Panagiotis ◽  
A Mischo ◽  
...  
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumors ◽  
High Dose Chemotherapy ◽  
Salvage Treatment ◽  
High Dose ◽  
First Relapse

Consolidative high-dose chemotherapy (HDCT) after conventional-dose chemotherapy (CDCT) as first salvage treatment for male patients (pts) with metastatic germ cell tumors (mGCTs).

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 336-336
Author(s):  
Michel S Beausoleil ◽  
Kylea R. Potvin ◽  
Kang Howson-Jan ◽  
D. Scott Ernst ◽  
Larry Stitt ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Germ Cell Tumors ◽  
Risk Groups ◽  
High Dose Chemotherapy ◽  
Risk Category ◽  
High Dose ◽  
Stem Cell Rescue ◽  
Conventional Dose ◽  
Male Patients ◽  
Pure Seminoma

336 Background: Some men with mGCTs progressing after response to initial cisplatin-based combination chemotherapy are cured with CDCT as 1st salvage, however, many are not. Prognosis has recently been better defined by the IPFSG prognostic factors. HDCT with autologous stem cell rescue has been routinely offered after CR/PRm- remission with CDCT at our institution over the past two decades. We retrospectively reviewed our data to assess the validity of the IPFSG prognostic factors and evaluate the potential value of this approach. Methods: Eligible men with mGCTs progressing after at least 3 cycles of cisplatin-based chemotherapy received after 01 Jan 1990 and treated with cisplatin-based CDCT+/−HDCT (etoposide + carboplatin) were identified and data collected. Pts were classified into risk groups using IPFSG factors, PFS and OS were analyzed and results for CDCT+/−HDCT compared. Results: 38 eligible 1st salvage pts had received a median of 4 cycles (range, 1–7) of CDCT. 20 pts received CDCT alone & 18 pts received CDCT+HDCT. Overall median PFS was 24.6 months (95%CI, 7.3–28.7) and overall median OS was 34.6 months (95%CI, 17.2–51.3). Distribution by IPFSG category, 2-year PFS and 3-year OS rates within each risk category were very similar to IPFSG results. Two toxic deaths occurred with CDCT. Pts treated with CDCT+HDCT more often had better responses to 1st-line chemotherapy and pure seminoma histology. Overall pts treated with CDCT+HDCT had improved PFS (HR: 0.18; 95%CI, 0.07–0.51; p=0.001) and OS (HR: 0.25; 95%CI, 0.10–0.65; p=0.004) compared to CDCT alone. Examination by IPFSG risk category showed that the 2-year PFS and 3-year OS rates for CDCT+HDCT was higher in all prognostic groups except for the very high risk which did not have any HDCT pts. Conclusions: The IPFSG prognostic factors were valid in our 1st salvage mGCT pts. The safety of HDCT with etoposide and carboplatin was confirmed. HDCT was associated with improved PFS and OS outcomes, consistent with observations of Lorch et al (JCO 2011). Ideally the value of optimal CDCT+HDCT should be determined in comparison to optimal CDCT as first salvage therapy in men with metastatic GCT in a randomized trial.

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