High dose chemotherapy and stem cell support for poor risk and recurrent nonseminomatous germ cell cancer: initial experience with sequential therapy

2002 ◽  
Vol 171 (3) ◽  
pp. 158-160 ◽  
Author(s):  
B. Hennessy ◽  
J. A. McCaffrey ◽  
P. Daly ◽  
P. Browne ◽  
M. J. Kennedy
Keyword(s):  
Stem Cell ◽  
Germ Cell ◽  
Cell Cancer ◽  
Sequential Therapy ◽  
High Dose Chemotherapy ◽  
Germ Cell Cancer ◽  
High Dose ◽  
Initial Experience ◽  
Stem Cell Support ◽  
Cell Support

High-dose chemotherapy and stem cell support in the management of metastatic germ cell cancer: A quantitative review

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16094-e16094
Author(s):  
H. S. Bozcuk ◽  
M. Ozdogan ◽  
H. S. Coskun ◽  
H. Mutlu ◽  
A. Kargi ◽  
...  
Keyword(s):  
Stem Cell ◽  
Germ Cell ◽  
Cell Cancer ◽  
High Dose Chemotherapy ◽  
Germ Cell Cancer ◽  
High Dose ◽  
Quantitative Review ◽  
Stem Cell Rescue ◽  
Risk Patients ◽  
Cell Support

e16094 Background: To analyze the independent associates of outcome in metastatic germ cell cancer (MGCC) patients treated with high dose chemotherapy (HDC) and stem cell rescue. Methods: Thirty-two published patient cohorts with MGCC (encompassing 2176 patients; 510 patients treated upfront and 1666 at relapse) were identified from PUBMED and Cochrane Registry of Clinical Trials. Weighed Regression Analyses of these trials were conducted to define prognosticators. Results: Correlate of overall survival (OAS) and survival with no evidence of disease (NED) in upfront HDC trials was number of chemotherapeutics in HDC (OAS with 2 agents: 60% vs. 3 or more agents: 72%, p = 0.047, survival with NED with 2 agents: 47% vs. 3 or more agents: 64%, p = 0.009). In trials of HDC at relapse, independent associates of OAS with multivariate analysis were line of chemotherapy index, an indicator of line of chemotherapy utilization (p = 0.004), and median age (≤30: 42%, >30: 49%, p = 0.023), whereas independent correlates of better survival with NED were again number of chemotherapeutics in HDC (2 agents: 54% vs. 3 or more agents: 33%, p = 0.001), and seminoma fraction (seminoma fraction ≤9%: 28% vs. seminoma fraction >9%: 49%, p < 0.001 ). Toxic mortality of HDC regimens employed in these trials ranged between 0% and 17%. Conclusions: HDC can cure patients with MGCC both as initial or salvage therapies. However, this study shows that type and setting of HDC, as well as patient age, and seminoma fraction all appear to be linked with benefit from HDC in MGCC. Future trials should continue to address the usage of tandem HDC cycles with multiagent protocols in high risk patients with MGCC. No significant financial relationships to disclose.

Long-Term Results of First-Line Sequential High-Dose Etoposide, Ifosfamide, and Cisplatin Chemotherapy Plus Autologous Stem Cell Support for Patients With Advanced Metastatic Germ Cell Cancer: An Extended Phase I/II Study of the German Testicular Cancer Study Group

2003 ◽  
Vol 21 (22) ◽  
pp. 4083-4091 ◽  
Author(s):  
H.-J. Schmoll ◽  
C. Kollmannsberger ◽  
B. Metzner ◽  
J.T. Hartmann ◽  
N. Schleucher ◽  
...  
Keyword(s):  
Stem Cell ◽  
Germ Cell ◽  
Poor Prognosis ◽  
Cell Cancer ◽  
Germ Cell Cancer ◽  
Long Term Results ◽  
High Dose ◽  
Stem Cell Support ◽  
Cell Support

Purpose: Patients with disseminated germ cell cancer and poor prognosis (International Germ Cell Cancer Collaborative Group [IGCCCG] classification) achieve only a 45% to 50% long-term survival by standard chemotherapy. First-line high-dose chemotherapy might be able to improve the result. This analysis reports toxicity and long-term results of a large phase I/II study of sequential high-dose etoposide, ifosfamide, and cisplatin (VIP) in patients with advanced germ cell tumors. Patients and Methods: Between July 1993 and November 1999, 221 patients with either Indiana “advanced disease” (n = 39) or IGCCCG “poor prognosis” criteria (n = 182) received one cycle of VIP followed by three to four sequential cycles of high-dose VIP chemotherapy plus stem cell support, every 3 weeks, at six consecutive dose levels. Results: Dose limiting toxicity occurred at level 8 (100 mg/m2 cisplatinum, 1750 mg/m2 etoposide, 12 g/m2 ifosfamide) with grade 4 mucositis (three of eight patients), grade 3 CNS toxicity (one of eight patients), grade 4 renal toxicity (one of eight patients), and prolonged granulocytopenia (one of eight patients). After 4-year median follow-up, progression-free survival and disease-specific survival rates in the poor prognosis subgroup were 69% and 79% at 2 years and 68% and 73% at 5 years, with 76% for gonadal/retroperitoneal versus 67% for mediastinal primaries. Severe toxicity included treatment related death (4%), treatment-related acute myeloid leukemia (1%), long-term impared renal function (3%), chronic renal failure (1%), and persistant grade 2–3 neuropathy (5%). Conclusion: Repetitive cycles of high-dose VIP with peripheral stem cell support can be successfully applied in a multicenter setting. Dose level 6 with cisplatin 100 mg/m2, etoposide 1500 mg/m2, and ifosfamide 10 g/m2 is recommended for further investigation in randomized trials. An ongoing randomized trial within the European Organization for Research and Treatment of Cancer evaluates this protocol against four cycles of standard cisplatin, etoposide, and bleomycin.

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