Long-term outcome of salvage high-dose chemotherapy in patients with germ cell tumor with poor prognostic features

• Published in: Urologic oncology 2011-05, Vol.29 (3), p.284-290
• Main Authors: De Giorgi, Ugo, M.D, Rosti, Giovanni, M.D, Salvioni, Roberto, M.D, Papiani, Giorgio, M.D, Ballardini, Michela, Ph.D, Pizzocaro, Giorgio, M.D, Marangolo, Maurizio, M.D
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Carboplatin - administration & dosage; Cisplatin-refractory; Cyclophosphamide - administration & dosage; Drug Resistance, Neoplasm; Etoposide - administration & dosage; Female; Follow-Up Studies; Germ cell tumor; High-dose chemotherapy; Humans; Ifosfamide - administration & dosage; Male; Medical sciences; Middle Aged; Neoplasms, Germ Cell and Embryonal - drug therapy; Nephrology. Urinary tract diseases; Poor prognosis; Prognosis; Retrospective Studies; Salvage Therapy; Survival Rate; Testicular cancer; Time Factors; Tumors; Urology; Young Adult
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2009.03.030

Abstract Objective High-dose chemotherapy (HDCT) represents an option as salvage treatment for patients with resistant/refractory germ cell tumor (GCT). The objective of this retrospective analysis was to evaluate the long-term results of a single-center experience with salvage HDCT for GCT patients, and to validate the prognostic model proposed by Einhorn and colleagues [9]. Materials and methods Between 1986 and 2003, 100 GCT patients received salvage HDCT consisting of high-doses of carboplatin, etoposide ± cyclophosphamide, or ifosfamide. Twenty-four patients underwent a second HDCT cycle, and in 1 case, a third cycle was given with a median interval time of 6 weeks (range, 5–10). Results With a median follow-up of 8 years (range, 3–17); 6 of 32 (19%) patients with resistant GCT and 1 of 19 (5%) patients with cisplatin-refractory disease have been continuously disease-free, while none of the 16 patients with absolutely cisplatin-refractory GCT were alive at 1 year from HDCT treatment. In the PBPC era, HDCT appeared to be inapplicable in 32% of patients, mainly due to progressive disease during the induction/mobilizing phase. The prognostic model by Einhorn et al. for tandem HDCT did categorize our patients treated with a single HDCT cycle or low-dose intensity regimens in a very similar manner, but with inferior overall results. Conclusions Long-term results with a single HDCT cycle or a low dose-intensity multicycle HDCT regimen remained poor in patients with adverse prognostic features. The tandem HDCT regimen represents a major option for refractory GCTs and relapsed tumors in third-line or later therapy, while a single course of HDCT should be abandoned for these patients.