title: Analysis of salvage treatments for germ cell cancer patients who have relapsed after primary high-dose chemotherapy plus autologous stem cell support.
abstract: The aim of this study was to identify treatment strategies and therapeutic or clinical factors that predict for response to salvage therapy and survival in patients with metastatic 'Indiana advanced' or International Germ-Cell Cancer Collaborative Group (IGCCCG) poor prognosis' germ cell cancer (GCT) failing first-line sequential high-dose chemotherapy plus autologous stem cell support (HD-CT). A total of 58 'poor prognosis' patients who had relapsed after HD-CT were identified within two large prospective German first-line HD-CT trials (n=286) performed between March 1993 and March 2001. Salvage treatment consisted of the following: cisplatin-based conventional dose CTx+/-resection (19/58; 33%), non-cisplatin based CTx (16/58; 28%) or salvage HD-CT (14/58; 24%)+/-resection; resection (n=3) and/or radiation (n=5) only: 7 patients (12%); no specific therapy: 2 patients. 21 (38%) patients responded favourably (Complete Response (CR)/Partial Response (PR) marker-negative) to salvage therapy. The use of salvage HD-CT (2-year survival 48%; P=0.03, the complete resection of residual masses (2-year survival 42%; P=0.015) as well as a favourable response to salvage therapy (2-year survival: 31%, P=0.014) were the only variables on univariate analysis associated with an improved survival. The estimated 2-year overall survival rate is 32% (95% Confidence Interval CI: 29-45%). Approximately 30% of patients relapsing after first-line HD-CT will survive>2 years, particularly those patients who can be treated with a second HD-CT +and/or surgical resection. If feasible, complete surgical resection of residual tumours appears to be the most efficient treatment.
authors.affiliation: Department of Hematology/Oncology, University of Tuebingen, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Kollmannsberger
authors.forename: N
authors.initials: N
authors.lastname: Schleucher
authors.forename: O
authors.initials: O
authors.lastname: Rick
authors.forename: B
authors.initials: B
authors.lastname: Metzner
authors.forename: J T
authors.initials: JT
authors.lastname: Hartmann
authors.forename: P
authors.initials: P
authors.lastname: Schöffski
authors.forename: J
authors.initials: J
authors.lastname: Beyer
authors.forename: J
authors.initials: J
authors.lastname: Casper
authors.forename: M
authors.initials: M
authors.lastname: Sosada
authors.forename: H-J
authors.initials: HJ
authors.lastname: Schmoll
authors.forename: I
authors.initials: I
authors.lastname: Böhlke
authors.forename: C
authors.initials: C
authors.lastname: Meisner
authors.forename: L
authors.initials: L
authors.lastname: Kanz
authors.forename: C
authors.initials: C
authors.lastname: Bokemeyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005834:Genital Neoplasms, Male / Q000188:drug therapy* / Q000628:therapy; D018237:Germinoma / Q000188:drug therapy* / Q000628:therapy; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000188:drug therapy* / Q000628:therapy; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012186:Retroperitoneal Neoplasms / Q000188:drug therapy* / Q000628:therapy; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D033581:Stem Cell Transplantation / Q000379:methods*; D016019:Survival Analysis