Pilot study of a high-dose carboplatin-based salvage strategy for relapsing or refractory germ cell cancer.
Eleven patients with germ cell cancer relapsing from a complete remission and 7 patients with refractory germ cell cancer and/or an unresectable partial remission received salvage chemotherapy with one to two courses of carboplatin (800 mg/m2) and etoposide (500 mg/m2 on days 1, 3, and 5), followed by either one or two courses of carboplatin (1600 mg/m2), cyclophosphamide (6 g/m2), and thiotepa (480 mg/m2) divided over 4 days with autologous bone marrow transplantation and/or peripheral stem cell support. Eight of 11 relapsing patients (73%) were salvaged (with a follow-up of 21+ to 56+ months), but only 1 of the 7 refractory patients survived (34+ months). The high-dose carboplatin-based salvage regimen is feasible and deserves further evaluation in patients relapsing from a complete remission. Even more intensive treatment strategies may be required to salvage patients who are refractory to standard doses of platinating agents.
Rodenhuis
S
S
Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam.
van der Wall
E
E
ten Bokkel Huinink
W W
WW
Schornagel
J H
JH
Richel
D J
DJ
Vlasveld
L T
LT
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D016190:Carboplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005047:Etoposide / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D018237:Germinoma / Q000188:drug therapy* / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000628:therapy; D009369:Neoplasms / Q000188:drug therapy* / Q000628:therapy; D010865:Pilot Projects; D012086:Reoperation; D016879:Salvage Therapy; D013852:Thiotepa / Q000008:administration & dosage
D005047:Etoposide; D003520:Cyclophosphamide; D013852:Thiotepa; D016190:Carboplatin