Bevacizumab/high-dose chemotherapy with autologous stem-cell transplant for poor-risk relapsed or refractory germ-cell tumors

Nieto, Yago; Tu, Shi Ming; Bassett, R.; Jones, Roy B.; Gulbis, Alison; Tannir, Nizar M.; Kingham, Ashley; Ledesma, Celina; Margolin, Kim; Holmberg, L.; Champlin, R.; Pagliaro, Lance C.

doi:10.1093/annonc/mdv479

Cited by 5 publications

(5 citation statements)

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“…The objective response rate was high at 89% in an overall heterogeneous patient population (including 14% cisplatin-sensitive patients). As excess toxicity with a mortality rate of 9% was reported and patients receiving bevacizumab showed worse outcomes, bevacizumab-based HD-CT cannot be recommended [28]. …”

Section: Resultsmentioning

confidence: 99%

The Role of Salvage High-Dose Chemotherapy in Relapsed Male Germ Cell Tumors

Oing

Lorch

2018

Oncol Res Treat

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Germ cell tumors (GCT) are a unique tumor entity with excellent cure rates if guideline-endorsed treatment is thoroughly applied. Even patients with widespread metastatic disease can often be cured with cisplatin-based combination chemotherapy as part of a multimodal treatment approach. However, about 30% of patients with metastatic disease at initial presentation, corresponding to about 5-10% of all GCT patients, relapse or progress despite first-line treatment and therefore require salvage chemotherapy. Salvage systemic treatment either consists of conventional-dose cisplatin-based combination chemotherapy or sequential high-dose treatment with carboplatin and etoposide plus subsequent autologous stem cell support. This review is based on a comprehensive literature search of MEDLINE and conference proceedings of ESMO, ASCO, and EAU meetings until 2018 and provides an overview of current treatment options for germ cell cancer patients relapsing after or progressing during first-line cisplatin-based combination chemotherapy.

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Section: Resultsmentioning

confidence: 99%

The Role of Salvage High-Dose Chemotherapy in Relapsed Male Germ Cell Tumors

Oing

Lorch

2018

Oncol Res Treat

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“…Another trial treated 43 patients with GCTs with high doses of bevacizumab in combination with chemotherapy (gemcitabine, docetaxel and carboplatin). An ORR of 89% was achieved, but the high rate of side effects rendered this regimen infeasible in some patients (40). Further studies of anti-angiogenic agents in GCTs, including CC, may shed light on combination therapy and maintenance treatment.…”

Section: Treatmentmentioning

confidence: 99%

Pure testicular choriocarcinoma, a rare and highly malignant subtype with challenging treatment: A case report and review of the literature

Lei,

Wang

et al. 2023

Mol Clin Oncol

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Testicular choriocarcinoma (CC) is the rarest subtype of germ cell tumours (GCTs) of the testis, with a high malignant potential and early haematogenous metastasis. Radical surgical resection should be performed primarily for histological diagnosis, while chemotherapy remains the mainstay of therapy for advanced disease. In the present study, the case of a 65-year-old male patient diagnosed with metastatic testicular CC, who did not fully respond to chemotherapy is reported. This patient underwent surgical removal of the testicular tumour, chemotherapy with etoposide and cisplatin, and radiotherapy of the intracranial lesions. Although the serum human chorionic gonadotropin (HCG) levels of the patient and most of the metastases continued decreasing during chemotherapy, complete response was not achieved after six cycles of chemotherapy. The patient refused high-dose chemotherapy and autologous stem cell transplantation due to severe side effects, and eventually developed respiratory failure on maintenance therapy with oral etoposide. A literature review was then performed, aiming to summarize the characteristics and therapeutic principles of testicular CC. In addition, the emerging therapeutic agents that could be used in maintenance therapy for GCTs, particularly for testicular CC, were also discussed. The limited clinical trials of targeted treatments showed potential benefit for long survival of patients with selected GCTs with fewer side effects. In particular, immunotherapy showed unique potential for testicular CC in preclinical studies, offering new approaches of maintenance therapy for advanced disease. Further studies should shed light on the identification of prognostic factors that predict the response to immune-based therapy in GCTs.

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“…Nieto et al demonstrated bevacizumab, combined with chemotherapy in treating the platinum-resistant and refractory diseases in adults, had shown encouraging results but needed further confirmation for this treatment strategy. The associated toxicity should be taken into consideration [ 64 ]. Frankhauser et al found that the expression of PD-1 and PDL-1 were high in GCTs which may bring insight to immune checkpoint inhibitor treatment [ 65 ].…”

Section: Pediatric Extracranial Germ Cell Tumormentioning

confidence: 99%

“…The TGM 95 trial evaluated 19 patients with relapsed and refractory diseases; the 5 years EFS and OS were 26% and 32% respectively even after various chemotherapy and surgical treatments [ 57 ]. Even the radiation therapy or appropriate targeted therapy, based on the results of genetic alterations of the tumor were applied, but, in recent years, treatment results have not significantly improved the survival rate for patients with poor-risk or relapsed GCTs [ 64 ]. In order to improve the survival rate of patients with poor-risk GCTs, it might be beneficial to identify which patients are poor-risk and assess application of second-line salvage chemotherapy or adjuvant therapy.…”

Section: High Dose Chemotherapy and Autologous Stem Cell Transplantat...mentioning

confidence: 99%

Pediatric Extracranial Germ Cell Tumors: Review of Clinics and Perspectives in Application of Autologous Stem Cell Transplantation

Lew

Liu

Hou

et al. 2023

Cancers

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Pediatric extracranial germ cell tumors (GCTs) are rare, accounting for approximately 3.5% of childhood cancers. Since the introduction of platinum-based chemotherapy, the survival rate of patients has improved to more than 80%. However, poor-risk subtypes of pediatric extracranial GCTs do not respond well to chemotherapy, leading to refractory or relapsed (R/R) diseases. For example, long-term survival rates of mediastinal GCTs or choriocarcinoma are less than 50%. According to reports in recent years for adult patients with R/R GCTs, the use of high-dose chemotherapy (HDCT) combined with autologous stem cell transplantation (ASCT) has clinical advantages; however, HDCT combined with ASCT has rarely been reported in pediatric GCTs. The R/R and poor-risk groups of pediatric GCTs could benefit from HDCT and ASCT.

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Bevacizumab/high-dose chemotherapy with autologous stem-cell transplant for poor-risk relapsed or refractory germ-cell tumors

Cited by 5 publications

References 0 publications

The Role of Salvage High-Dose Chemotherapy in Relapsed Male Germ Cell Tumors

The Role of Salvage High-Dose Chemotherapy in Relapsed Male Germ Cell Tumors

Pure testicular choriocarcinoma, a rare and highly malignant subtype with challenging treatment: A case report and review of the literature

Pediatric Extracranial Germ Cell Tumors: Review of Clinics and Perspectives in Application of Autologous Stem Cell Transplantation

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