title: High-dose chemotherapy with hematopoietic stem-cell support in germ-cell tumor patient treatment: the French experience.
abstract: Germ-cell tumors (GCTs) are very chemosensitive and highly curable cancers. For the small proportion of patients who fail conventional chemotherapy (CT), high-dose CT (HDCT) was introduced in France and elsewhere in 1982-1984. We report here on the French experience with HDCT in GCTs. At the Centre Léon Bérard, 75 patients were treated with HDCT between 1982 and 1996. Patients received HDCT in 2 different settings: 46 in consolidation of first-line treatment or in incomplete response, 29 in salvage of relapse or refractory disease. The most common regimens of HDCT were the combination of etoposide, double-dose cisplatin and either ifosfamide (VIC regimen, n = 46) or cyclophosphamide (PEC regimen, n = 9) and the combination of carboplatin, etoposide and cyclophosphamide (Carbo-PEC regimen, n = 17). Seven patients died of toxicity. The median follow-up was 42 months. Forty-five of 75 patients are alive and free of disease at long term, 2 of whom had refractory disease. The median time to recovery of a granulocyte count > or = 0.5 x 10(9)/l and a platelet count > or = 25 x 10(9)/l was 14 and 11 days, respectively. The French development was based on double-dose cisplatin until the results of the French randomized trial, which showed no advantage of HDCT in the first-line treatment of poor-risk group patients. Then carboplatin was associated with etoposide and cyclophosphamide in a phase I trial. A European randomized trial, which studies the role of HDCT in the first-line salvage treatment of non-refractory disease, is ongoing. So far, HDCT is not a standard treatment of GCT.
authors.affiliation: Groupe d'Etude des Tumeurs Uro-Génitales (GETUG), French Federation of Cancer Centers, Paris, France. flechon@lyon.fnclcc.fr
authors.forename: A
authors.initials: A
authors.lastname: Fléchon
authors.forename: P
authors.initials: P
authors.lastname: Biron
authors.forename: J P
authors.initials: JP
authors.lastname: Droz
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood; D003131:Combined Modality Therapy; D005602:France; D018237:Germinoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy; D018239:Seminoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000628:therapy; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000628:therapy*
chemical_list: D014408:Biomarkers, Tumor