Long-term survival of patients with recurrent or refractory germ cell tumors after high dose chemotherapy.
BACKGROUND
The optimal treatment of patients with recurrent or refractory germ cell tumors is still a debated topic. High dose chemotherapy (HDCT) with autologous stem cell rescue (ASCR) might be promising for intensification of first or subsequent salvage treatment. However, the long-term results of this approach remain largely unknown.


METHODS
Between August 1989 and September 1992, 74 patients with recurrent and/or refractory germ cell tumors were treated in a Phase I/II trial with HDCT consisting of carboplatin (1500-2000 mg/m2), etoposide (1200-2400 mg/m2), and ifosfamide (0-10 g/m2). In September 1995 all patients were reevaluated to determine overall response, late toxicities, and survival.


RESULTS
Two patients died from treatment-related toxicity shortly after HDCT, and 47 had recurrence or progression of disease after a median of 3 months (range, 1-44 months). Of these latter patients, three were living continuously disease free at the conclusion of this study after a second HDCT regimen, salvage surgery, or chronic oral etoposide treatment. The results were an overall survival of 38% (95% confidence interval, 27-50%) and a failure free survival of 31% (95% confidence interval, 21-43%) at 5 years. There were no long-term survivors among patients whose disease progressed while they were receiving conventional doses of cisplatin before HDCT. Late toxicities consisted mainly or renal impairment (in 21% of patients), paresthesias (in 29%), and ototoxicity (in 18%).


CONCLUSIONS
HDCT can be curative for patients with germ cell tumors who do not become disease free after conventional dose chemotherapy but respond to this treatment.
Beyer
J
J
Department of Internal Medicine, Virchow Clinic, Humboldt University, Berlin, Germany.
Kingreen
D
D
Krause
M
M
Schleicher
J
J
Schwaner
I
I
Schwella
N
N
Huhn
D
D
Siegert
W
W
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D018237:Germinoma / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008479:Mediastinal Neoplasms / Q000188:drug therapy* / Q000401:mortality; D008875:Middle Aged; D012186:Retroperitoneal Neoplasms / Q000188:drug therapy* / Q000401:mortality; D016879:Salvage Therapy; D017741:Survivors; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000401:mortality
D005047:Etoposide; D016190:Carboplatin; D007069:Ifosfamide