High-dose chemotherapy and stem-cell rescue for metastatic germ-cell tumors.

Abstract

BACKGROUND:

Metastatic testicular tumors that have not been successfully treated by means of initial chemotherapy are potentially curable with salvage chemotherapy.

METHODS:

We conducted a retrospective review of 184 consecutive patients with metastatic testicular cancer that had progressed after they received cisplatin-containing combination chemotherapy. We gave 173 patients two consecutive courses of high-dose chemotherapy consisting of 700 mg of carboplatin per square meter of body-surface area and 750 mg of etoposide per square meter, each for 3 consecutive days, and each followed by an infusion of autologous peripheral-blood hematopoietic stem cells; the other 11 patients received a single course of this treatment. In 110 patients, cytoreduction with one or two courses of vinblastine plus ifosfamide plus cisplatin preceded the high-dose chemotherapy.

RESULTS:

Of the 184 patients, 116 had complete remission of disease without relapse during a median follow-up of 48 months (range, 14 to 118). Of the 135 patients who received the treatment as second-line therapy, 94 were disease-free during follow-up; 22 of 49 patients who received treatment as third-line or later therapy were disease-free. Of 40 patients with cancer that was refractory to standard-dose platinum, 18 were disease-free. A total of 98 of 144 patients who had platinum-sensitive disease were disease-free, and 26 of 35 patients with seminoma and 90 of 149 patients with nonseminomatous germ-cell tumors were disease-free. Among the 184 patients, there were three drug-related deaths during therapy. Acute leukemia developed in three additional patients after therapy.

CONCLUSIONS:

Testicular tumors are potentially curable by means of high-dose chemotherapy plus hematopoietic stem-cell rescue, even when this regimen is used as third-line or later therapy or in patients with platinum-refractory disease.

• Authors: Lawrence H Einhorn, Stephen D Williams, Amy Chamness, Mary J Brames, Susan M Perkins, Rafat Abonour
• Journal: The New England journal of medicine (N Engl J Med) Vol. 357 Issue 4 Pg. 340-8 (Jul 26 2007) ISSN: 1533-4406 [Electronic] United States
• PMID: 17652649 (Publication Type: Journal Article)
• Copyright: Copyright 2007 Massachusetts Medical Society.

Chemical References

• Etoposide
• Cisplatin

Topics

• Adolescent
• Adult
• Algorithms
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Cisplatin (administration & dosage)
• Combined Modality Therapy
• Etoposide (administration & dosage)
• Follow-Up Studies
• Hematopoietic Stem Cell Transplantation
• Humans
• Male
• Middle Aged
• Neoplasm Recurrence, Local (drug therapy, therapy)
• Neoplasms, Germ Cell and Embryonal (drug therapy, mortality, secondary, therapy)
• Prognosis
• Proportional Hazards Models
• Remission Induction
• Retrospective Studies
• Salvage Therapy
• Survival Analysis
• Testicular Neoplasms (drug therapy, mortality, pathology, therapy)