HIGH DOSE CHEMOTHERAPY FOR RELAPSED-REFRACTORY GERM CELL TUMORS

In a retrospective analysis reported in the Journal of Clinical Oncology, Adra et al found that good survival outcomes were achieved with the use of high-dose chemotherapy and peripheral blood stem cell transplantation (PBSCT) in second-, third-, or later-line treatment of patients with relapsed metastatic germ cell tumors at Indiana University.

The study included 364 consecutive patients with germ cell tumors between 2004 and 2014 who progressed after cisplatin-based combination chemotherapy and were treated with high-dose chemotherapy and PBSCT. Of them, 341 received 2 consecutive courses of high-dose chemotherapy consisting of carboplatin at 700 mg/m2 and etoposide at 750 mg/m2 each for 3 consecutive days followed by PBSCT; 23 patients received only 1 course of high-dose chemotherapy due to disease progression or toxicity.

Survival Outcomes

Median follow-up was 3.3 years. Among all patients, 2-year progression-free survival was 60% (95% confidence interval [CI] = 55%–65%), and 2-year overall survival was 66% (95% CI = 60%–70%). Among 303 patients receiving high-dose chemotherapy as second-line treatment, 2-year progression-free survival was 63% (95% CI = 57%–68%), and 2-year overall survival was 67% (95% CI = 61%–72%).

Among 61 patients receiving high-dose chemotherapy as third-line or later therapy, 2-year progression-free survival was 49% (95% CI = 36%–61%; P = .03, vs second line), and 2-year overall survival was 60% (95% CI = 46%–71%; P = .05, vs second line). For patients with platinum-refractory vs platinum-sensitive disease, 2-year progression-free survival was 33% vs 75%, and 2-year overall survival was 37% vs 80%, respectively. Overall, nine treatment-related deaths occurred, and secondary leukemia developed in five patients.

The investigators concluded: “This large single-institution study demonstrates that patients with relapsed metastatic [giant cell tumor] are curable by [high-dose chemotherapy] plus PBSCT even when used in third-line or later therapy.”

The study was supported in part by the National Cancer Institute.

Nabil Adra, MD, of Indiana University, Indianapolis, is the corresponding author of the Journal of Clinical Oncology article.