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High-dose chemotherapy, stem-cell rescue effective against testicular tumors
One hundred sixteen of 184 patients assigned to the regimen had complete remission without relapse during four-year follow-up.
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High-dose chemotherapy plus hematopoietic stem-cell rescue increased disease-free survival for patients with testicular tumors, even when used as third-line therapy or later in patients with platinum-refractory disease, according to recent study results.
“Cisplatin-containing combination chemotherapy cures 70% of patients with newly-diagnosed metastatic germ-cell tumors. Prognostic factors, based on data from more than 5,000 such patients, are well established,” researchers wrote in The New England Journal of Medicine. “The factors associated with long-term survival after salvage therapy, however, are less well established.”
Researchers from Indiana University School of Medicine and the Walther Cancer Institute in Indianapolis conducted a retrospective review of patients with metastatic testicular cancer. They included 184 patients whose disease progressed after they had received combination chemotherapy containing cisplatin. The median age of patients was 31.
The researchers assigned the patients to two consecutive courses of high-dose chemotherapy, including 700 mg/m2 of carboplatin and 750 mg/m2 of etoposide for three consecutive days.
Both drugs were followed by an infusion of autologous peripheral-blood hematopoietic stem cells. For 110 of the patients, cytoreduction with one or two courses of vinblastine, ifosfamide and cisplatin preceded the high-dose chemotherapy.
Disease-free survival
During a median follow-up of four years, 116 patients had complete remission without relapse. For 135 patients, the treatment was second-line therapy. Ninety-four of these patients were disease-free during follow-up. Of the 49 patients for whom this treatment was third-line therapy or later, 22 were disease-free.
Eighteen of 40 patients who had cancer that was refractory to standard-dose platinum were disease-free during follow-up. Also disease-free were 98 of 114 patients who had platinum-sensitive disease, 26 of 35 patients with seminoma and 90 of 149 patients with nonseminomatous germ-cell tumors.
The researchers observed three drug-related deaths during therapy. Three other patients developed acute leukemia after therapy.
“There should be little or no debate on the use of high-dose chemotherapy for a patient with a germ-cell tumor that is refractory to platinum-based chemotherapy or that is not cured by a cisplatin-ifosfamide regimen as salvage chemotherapy,” wrote the researchers.
Editor’s Note: This work is a careful and thoughtful analysis of a large clinical series. These data, which evaluate the largest experiences in the use of high-dose chemotherapy in men with refractory germ cell tumors, clearly indicate the potential for high-dose chemotherapy to provide long-term control in patients with germ cell tumors that have progressed despite cisplatin-based salvage therapy. This can help delineate patients at high risk of unfavorable outcome. These are important and useful data that confirm the value of this approach in these patients with a very difficult clinical problem. – Donald Trump, MD
For more information:
- Einhorn LH, Williams SD, Chamness A, et al. High-dose chemotherapy and stem-cell rescue for metastatic germ-cell tumors. N Engl J Med. 2007;357:340-348.