High-dose chemotherapy in adult patients with germ cell tumors.
BACKGROUND
Approximately 80% of patients with advanced germ cell tumors (GCTs) can be cured with cisplatin-based chemotherapy. Patients with poor-prognosis disease have a cure rate of only 50%, whereas patients with first relapse have only a 25% chance of prolonged survival and potential cure following standard therapy. High-dose chemotherapy (HDC) is being investigated in patients with GCTs to improve the results of salvage treatment and in first-line setting for poor prognosis disease.


METHODS
The authors review the results of the clinical trials that have evaluated the role of HDC in GCT patients. Data were obtained using a computer-assisted MEDLINE search, and meeting abstracts with clinical relevance in this field were hand-searched. Open randomized phase III studies are described and examined.


RESULTS
Several phase II studies have shown a possible benefit for patients with recurrent disease, but the preliminary results of a phase III randomized trial did not demonstrate a survival advantage for HDC after three courses of standard-dose chemotherapy in the salvage therapy of patients in whom first-line treatment has failed. Three prospective, randomized trials are evaluating the role of HDC in a first-line setting.


CONCLUSIONS
New HDC strategies are emerging, involving new drugs (eg, paclitaxel), intensive induction regimens, and upfront and/or multiple courses of HDC. The evaluation of mature data of randomized trials will better define the role of HDC in this disease.
De Giorgi
Ugo
U
Department of Oncology and Hematology, General Hospital, 48100 Ravenna, Italy. ugo.degiorgi@ra.nettuno.it
Papiani
Giorgio
G
Severini
Giuseppe
G
Fiorentini
Giammaria
G
Marangolo
Maurizio
M
Rosti
Giovanni
G
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D002986:Clinical Trials as Topic; D018237:Germinoma / Q000188:drug therapy*; D006801:Humans; D011379:Prognosis; D016879:Salvage Therapy; D033581:Stem Cell Transplantation