Twenty-four patients with metastatic and
chemotherapy-refractory nonseminomatous
germ cell tumors of the testis were treated with various
chemotherapy regimens upon failure. Eight of the 24 patients (33%) are alive and disease-free after
salvage therapy with a median follow-up of sixteen months. Prognostic factors tested included those known to be predictive for initial response to
therapy (clinical stage and degree of elevation of the
biomarkers). In addition, time to initiation of
salvage therapy and response to initial
chemotherapy were assessed as variables. Our data suggest that patients with solitary organ
metastases following relapse, and response to initial
chemotherapy are favorable predictors for response to
salvage treatment. All the patients with solitary organ
metastases (5/5 [100%]) but only 3/19 (16%) of the patients with multiple metastatic sites were salvaged. Patients with delayed initiation of
salvage therapy had a reduced likelihood of achieving a complete remission but this was not statistically significant. The variables identified need to be incorporated into future trials testing the efficacy of
salvage therapy for patients with nonseminomatous
tumors of the testis.