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Long-term outcome of salvage high-dose chemotherapy in patients with germ cell tumor with poor prognostic features
Urologic Oncology: Seminars and Original Investigations, 07/24/09

De Giorgi U et al. - In a trial to evaluate the long-term results of a single-center experience with salvage high-dose chemotherapy (HDCT) for germ cell tumor (GCT) pts and to validate the prognostic model proposed by Einhorn and colleagues, it appears that long-term results with a single HDCT cycle or a low dose-intensity multicycle HDCT regimen remained poor in pts 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 pts.

Methods

100 GCT pts received salvage HDCT consisting of high-doses of carboplatin, etoposide ± cyclophosphamide, or ifosfamide.
24 pts underwent a second HDCT cycle, and in 1 case, a third cycle was given with a median interval time of 6 wks.

Results

With median follow-up of 8 yrs, 6 of 32 (19%) pts with resistant GCT and 1 of 19 (5%) pts with cisplatin-refractory disease have been continuously disease-free, while none of the 16 pts with absolutely cisplatin-refractory GCT were alive at 1 yr from HDCT treatment.
In the PBPC era, HDCT appeared to be inapplicable in 32% of pts, mainly due to progressive disease during the induction/mobilizing phase.
The prognostic model by Einhorn et al. for tandem HDCT did categorize pts treated with a single HDCT cycle or low-dose intensity regimens in a very similar manner, but with inferior overall results.

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