title: Long-term results of first-line sequential high-dose carboplatin, etoposide and ifosfamide chemotherapy with peripheral blood stem cell support for patients with advanced testicular germ cell tumor.
abstract: OBJECTIVE
  Standard chemotherapy shows relatively low long-term survival in patients with poor-risk testicular germ cell tumor (GCT). First-line high-dose chemotherapy (HD-CT) may improve the result. High-dose carboplatin, etoposide, ifosfamide chemotherapy followed by autologous peripheral blood stem cell transplantation (PBSCT) was investigated as first-line chemotherapy in patients with advanced testicular GCT.
  
  
  METHODS
  Fifty-five previously untreated testicular GCT patients with Indiana 'advanced disease' criteria received three cycles of bleomycin, etoposide and cisplatin (BEP) followed by one cycle of HD-CT plus PBSCT, if elevated serum tumor markers were observed after three cycles of the BEP regimen.
  
  
  RESULTS
  Thirty patients were treated with BEP alone, because the tumor marker(s) declined to normal range. Twenty-five patients received BEP and HD-CT. One patient died of rhabdomyolysis due to HD-CT. Three and six (13% and 25%) out of 24 patients treated with BEP and HD-CT achieved marker-negative and marker-positive partial responses, respectively. The other patients achieved no change. Fifteen (63%) are alive and 14 (58%) are free of disease at a median follow-up time of 54 months. Severe toxicity included treatment-related death (4%).
  
  
  CONCLUSIONS
  HD-CT with peripheral stem cell support can be successfully applied in a multicenter setting. HD-CT demonstrated modest anticancer activity for Japanese patients with advanced testicular GCT and was well tolerated. This regimen might be examined for further investigation in randomized trials in first-line chemotherapy for patients with poor-risk testicular GCT.
authors.affiliation: Department of Urology, Kyoto Prefectural University of Medicine, Graduate School of Medical Sciences, Kyoto, Japan. tmiki@koto.kpu-m.ac.jp
authors.forename: Tsuneharu
authors.initials: T
authors.lastname: Miki
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Mizutani
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Akaza
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Ozono
authors.forename: Taiji
authors.initials: T
authors.lastname: Tsukamoto
authors.forename: Toshiro
authors.initials: T
authors.lastname: Terachi
authors.forename: Katsusuke
authors.initials: K
authors.lastname: Naito
authors.forename: Norio
authors.initials: N
authors.lastname: Nonomura
authors.forename: Isao
authors.initials: I
authors.lastname: Hara
authors.forename: Osamu
authors.initials: O
authors.lastname: Yoshida
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005047:Etoposide / Q000008:administration & dosage; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation; D013736:Testicular Neoplasms / Q000628:therapy*; D013997:Time Factors
chemical_list: D005047:Etoposide; D016190:Carboplatin; D007069:Ifosfamide