Treating relapsed and refractory metastatic germ cell tumours with high-dose chemotherapy with carboplatin and etoposide and autologous haematopoietic stem cell transplantation
Restricted accessResearch articleFirst published online October, 2021
Treating relapsed and refractory metastatic germ cell tumours with high-dose chemotherapy with carboplatin and etoposide and autologous haematopoietic stem cell transplantation
To demonstrate the real-life data about patients who underwent AHSCT due to GCT.
Methods
Between November 2016 and April 2020, 64 patients who received CE as high-dose chemotherapy for AHSCT in the Gulhane Education and Research Hospital were included in the study. Sixty-one patients received one AHSCT with CE chemotherapy regimen. Survival data and clinical characteristics were evaluated retrospectively.
Results
The mean age of the patients were 31.9 ± 9 (min-max:18–55). With a median follow-up of 10.7 ± 8.7 months, the 1-year progression-free survival (PFS) rate was 57.8%, and the 1-year overall survival rate was 77.5%. Median overall survival (OS) and progression-free survival (PFS) times were 21.5 ± 1.8 (95% CI: 14.5–33.4) and 20 ± 2 months, respectively. The response rate was 72%. There were three treatment-related deaths.
Conclusion
This sizeable single-centre study shows that patients with relapsed metastatic GCT are curable by CE as high dose chemotherapy plus AHSCT with reliable toxicity even for a single cycle.
SiegelRLMillerKDJemalA.Cancer statistics, 2016. CA Cancer J Clin2016;
66: 7–30.
2.
AdraNAbonourRAlthouseSK, et al.
High-dose chemotherapy and autologous peripheral-blood stem-cell transplantation for relapsed metastatic germ cell tumors: the Indiana University experience. J Clin Oncol2017;
35: 1096.
3.
International Germ Cell Cancer Collaborative Group.International germ cell consensus classification: a prognostic factor-based staging system for metastatic germ cell cancers. J Clin Oncol1997;
15: 594–603.
4.
AdraNKuKKalraM, et al.
Survival outcomes of patients with metastatic germ cell tumor (mGCT) treated from 1998 to 2012: the Indiana University (IU) experience. JCO2016;
34: 491–491.
5.
SchraderMKempkensteffenCChristophF, et al.
Germ cell tumors of the gonads: a selective review emphasizing problems in drug resistance and current therapy options. Oncology2009;
76: 77–84.
6.
FeldmanDRBoslGJSheinfeldJ, et al.
Medical treatment of advanced testicular cancer. JAMA2008;
299: 672–684.
7.
OlofssonSETandstadTJerkemanM, et al.
Population-based study of treatment guided by tumor marker decline in patients with metastatic nonseminomatous germ cell tumor: a report from the Swedish-Norwegian testicular cancer group. J Clin Oncol2011;
29: 2032–2039.
8.
VaenaDAAbonourREinhornLH.Long-term survival after high-dose salvage chemotherapy for germ cell malignancies with adverse prognostic variables. J Clin Oncol2003;
21: 4100–4104.
9.
PicoJLRostiGKramarA, et al.
A randomised trial of high-dose chemotherapy in the salvage treatment of patients failing first-line platinum chemotherapy for advanced germ cell tumours. Ann Oncol2005;
16: 1152–1159.
10.
AdraNAbonourRAlthouseSK, et al.
High-dose chemotherapy and autologous peripheral-blood stem-cell transplantation for relapsed metastatic germ cell tumors: the Indiana University experience. J Clin Oncol2017;
35: 1096–1102.
11.
EinhornLHWilliamsSDChamnessA, et al.
High-dose chemotherapy and stem-cell rescue for metastatic germ-cell tumors. N Engl J Med2007;
357: 340–348.
12.
KoJJBernardBTranB, et al.
Conditional survival of patients with metastatic testicular germ cell tumors treated with first-line curative therapy. J Clin Oncol2016;
34: 714–720.
13.
LorchAKleinhansAKramarA, et al.
Sequential versus single high-dose chemotherapy in patients with relapsed or refractory germ cell tumors: long-term results of a prospective randomized trial. J Clin Oncol2012;
30: 800–805.
14.
MohrMHartigIKesslerT, et al.
High-dose chemotherapy with autologous PBSC transplantation for poor prognosis germ cell tumors: a retrospective monocenter analysis of 44 cases. Bone Marrow Transpl2012;
47: 1321–1325.
15.
FeldmanDRSheinfeldJBajorinDF, et al.
TI-CE high-dose chemotherapy for patients with previously treated germ cell tumors: results and prognostic factor analysis. JCO2010;
28: 1706–1713.
16.
SelleFWittnebelSBironP, et al.
A phase II trial of high-dose chemotherapy (HDCT) supported by hematopoietic stem-cell transplantation (HSCT) in germ-cell tumors (GCTs) patients failing cisplatin-based chemotherapy: the multicentric TAXIF II study. Ann Oncol2014;
25: 1775–1782.
17.
RickOBokemeyerCBeyerJ, et al.
Salvage treatment with paclitaxel, ifosfamide, and cisplatin plus high-dose carboplatin, etoposide, and thiotepa followed by autologous stem-cell rescue in patients with relapsed or refractory germ cell cancer. J Clin Oncol2001;
19: 81–88.
18.
HegeSHAnnaLUlrikaS, et al.
High-dose chemotherapy with autologous stem cell support in patients with metastatic nonseminomatous testicular cancer – a report from the Swedish Norwegian testicular cancer group (SWENOTECA). Acta Oncologica2012;
51: 168–176.
19.
YilmazFSoyerNUsluR, et al.
Retrospective analysis of patients with relapsed or refractory testicular nonseminous germ cell tumors treated with autologous stem cell transplantation. Indian J Cancer2017;
54: 415–420.
20.
ColletteLSylvesterRJStenningSP, et al.
Impact of the treating institution on survival of patients with “poor-prognosis” metastatic nonseminoma. J Natl Cancer Inst1999;
91: 839–846.
