First-line sequential high-dose VIP chemotherapy with autologous transplantation for patients with primary mediastinal nonseminomatous germ cell tumours: a prospective trial

Abstract

To determine the efficacy of first-line sequential high-dose VIP chemotherapy (HD-VIP) in patients with primary mediastinal nonseminomatous germ cell tumours (GCT), 28 patients were enrolled on a German multicentre trial. High-Dose VIP chemotherapy consisted of 3 -4 cycles of dose-intensive etoposide and ifosfamide plus cisplatin, q22days, each cycle followed by autologous peripheral blood stem cell transplantation plus granulocyte-colony stimulating factor (G-CSF) support. One cycle of standard-dose VIP was applied to harvest peripheral blood stem cells. Ten patients had mediastinal involvement as the only manifestation (36 %), 18 of 28 patients had additional metastatic sites, such as lung (n ¼ 17; 61%), liver (n ¼ 7; 25%), bone (n ¼ 5; 18%), lymph nodes (n ¼ 3; 11%) and CNS (n ¼ 3; 11%). Median follow-up was 43 months (range, 7 -113) for all patients and 52 months (range, 22 -113) for surviving patients. Nineteen of 28 patients obtained a disease-free status; 11 with HD-VIP alone and eight with adjunctive surgery. In addition, one of the four patients with marker negative partial remission after HD-VIP without resection of residual masses is currently alive. Two patients developed recurrence of GCT or teratoma. Two patients have died due to an associated haematologic disorder. The 2-year progression-free survival and overall survival rates are 64 and 68%, respectively. This report represents a subgroup analysis of 28 patients with mediastinal nonsemina within the German first-line study for 'poor prognosis' GCT. Compared to data of an international database analysis including 253 patients with mediastinal nonseminoma treated with conventional chemotherapy, the results may indicate that HD-VIP results in an approximately 15% survival improvement.

Bone metastases in germ cell tumor patients

“…Despite the fact that the only randomized phase III study in ''intermediate'' and ''poor prognosis'' patients did not demonstrate a survival advantage for patients treated with primary high-dose chemotherapy and subsequent autologous stem cell transplantation compared to standard-dose chemotherapy (Motzer et al 2007), a number of non-randomized phase II clinical trials of the German Testicular Cancer Study Group have demonstrated excellent survival rates of up to 70-80% with first-line high-dose chemotherapy Bokemeyer et al 1999Bokemeyer et al , 2003Hartmann et al 2007).…”

Multimodality treatment of primary mediastinal germ cell tumor with growing teratoma syndrome: a case report

“…Bone marrow is affected by chemotherapy and regains the functions with ASCT. Bokemeyer et al [15] reported that according to "International Germ Cell Tumor Group Consensus Classification" the patients in the middle and poor prognosis groups benefit from high-dose chemotherapy and ASCT as a first treatment, instead of the standard treatment and the survey increases by %15. In this case, surgical excision followed by VIP chemotherapy and pathologic examination showed immature teratoma including 30%-40% necrosis.…”

“…Autologous stem cell transplantation following high-dose chemotherapy is defined as a treatment option for selected patients [8,15,16]. Bone marrow is affected by chemotherapy and regains the functions with ASCT.…”

Successful treatment of disseminated extragonadal germ cell cancer with intensive conventional chemotherapy after first-line high-dose chemotherapy

“…1 Recent medical efforts to treat such poor risk patients, including high-dose chemotherapy (HDCT) along with autologous peripheral blood stem cell (PBSC) support, have resulted in improved outcomes, although results are preliminary. [2][3][4] However, management of patients with residual cancer and poor prognoses after HDCT has not been well addressed. Here, we report a case of disseminated germ cell cancer successfully treated with intensive cisplatin-based standard-dose chemotherapy after first-line HDCT.…”