New approaches to the management of poor prognosis non-seminomatous germ cell tumours.
While most patients with disseminated non-seminomatous germ cell tumours (NSGCT) are cured by treatment with cisplatinum-based chemotherapy, a subset die from refractory or relapsing disease. Poor prognostic factors at diagnosis include bulky disease, visceral involvement, high serum marker levels and an inadequate rate of fall in these markers in response to treatment. There are a number of approaches to poorer risk patients. One is to use conventional induction chemotherapy followed by second-line salvage regimens in those who fail induction. Results with this approach have been disappointing. A second approach is to use more intensive induction regimens, in some cases with growth factor support; whether these are superior to standard treatment has yet to be established by randomised studies. A third approach, based on the chemotherapy-dose responsiveness of NSGCT, consists of the administration of very high dose chemotherapy followed by haematological rescue with autologous marrow to patients failing initial therapy. Review of autograft studies suggest that durable remissions can be obtained in most patients with responsive disease, but not if the disease is chemotherapy-refractory. A new approach may be elective early autografting in patients identified at diagnosis to have very poor prognosis disease.
Grigg
A
A
Department of Clinical Haematology, Royal Melbourne Hospital, Melbourne, Vic.
McKendrick
J
J
Fox
R
R
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation / Q000379:methods / Q000592:standards*; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D004407:Dysgerminoma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015672:Erythroid Precursor Cells; D006801:Humans; D011379:Prognosis; D016879:Salvage Therapy / Q000379:methods / Q000592:standards; D015996:Survival Rate; D014182:Transplantation, Autologous / Q000379:methods / Q000592:standards*; D016896:Treatment Outcome