Salvage, dose intense and high-dose chemotherapy for the treatment of poor prognosis or recurrent germ cell tumours

Cancer Treat Rev. 2005 May;31(3):197-209. doi: 10.1016/j.ctrv.2005.02.001. Epub 2005 Mar 19.

Abstract

Most patients with metastatic testicular cancer are cured with cisplatin-based chemotherapy regimens. However, about 20-30% of patients with poor-risk germ cell tumours either fail to respond adequately or relapse after initial complete response. In an attempt to improve the treatment results, several phase II studies of high-dose chemotherapy (HDCT) and haematopoeitic stem cell support were performed initially in refractory or heavily pre-treated patients with germ cell tumours (GCT). Long-term disease-free survival (DFS) has been reported in nearly 13% (range 0-35%) of the patients in this group. Subsequently, HDCT trials have been conducted in first relapse; long-term DFS has been seen in 45% of the patients in these trials (range 21-67%). HDCT has also been evaluated in the first-line treatment of poor-risk GCTs; long-term DFS was achieved in 52% of the patients in this group (range 36-84%). Despite these encouraging results, a French randomised trial has failed to demonstrate any advantage of HDCT in the first-line treatment of poor-risk GCTs and thus the place of HDCT in routine practice remains uncertain. A number of randomised trials of HDCT are currently ongoing in the United States and Europe to better define the role of HDCT in this disease.

Publication types

  • Review

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage*
  • Deoxycytidine / administration & dosage
  • Deoxycytidine / analogs & derivatives*
  • Disease-Free Survival
  • Drug Administration Schedule
  • Germinoma / drug therapy*
  • Germinoma / secondary
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Ifosfamide / administration & dosage
  • Organoplatinum Compounds / administration & dosage
  • Oxaliplatin
  • Paclitaxel / administration & dosage
  • Prognosis
  • Randomized Controlled Trials as Topic
  • Salvage Therapy / methods*

Substances

  • Organoplatinum Compounds
  • Oxaliplatin
  • Deoxycytidine
  • gemcitabine
  • Paclitaxel
  • Ifosfamide