High-dose chemotherapy and autologous haematopoietic support in poor risk non-seminomatous germ-cell tumours: An effective first-line therapy with minimal toxicity

Abstract

These results support the case of first-line HDCT. The excellent toxicity profile of BEP/CEC and the two-year overall survival of 78% are encouraging and support further the ongoing randomised US intergroup study evaluating high-dose CEC after BEP.

First-line high-dose chemotherapy for patients with poor prognosis extragonadal germ cell tumors: the experience of the European Bone Marrow Transplantation (EBMT) Solid Tumors Working Party

“…The first experiences with early HDCT in poor prognosis GCTs showed significantly improved overall and diseasefree survival for patients treated with HDCT compared with prior studies, based on standard-dose chemotherapy. 11,16,17 However, the only randomized trial published so far, comparing HDCT as late intensification after three courses of cisplatin, vinblastine, etoposide, and bleomycin (PVeEB) with four courses of PVeEB, showed no benefit for the HDCT arm. However, only 114 patients were randomized, PVeEB cannot be considered a standard treatment, and the dose intensity in the HDCT arm was low.…”

Long-term follow-up of patients with poor prognosis germ cell tumor treated with early high-dose chemotherapy with hematopoietic progenitor cell support: a single-center experience

“…The 2-year overall survival rate was 78%, while the 4-year overall survival rate was 66%. 18 In our experience with chemotherapeutic regimens including one or two courses of early HDCT after induction chemotherapy, 12 (67%) patients achieved a CR and they are continuously disease-free at a median follow-up of 9.2 years (range, 1.7-16.2). Interestingly, of 12 patients achieving a CR after HDCT no patient relapsed, while the five patients, achieving one PRm þ , three SD and one PD, died within 16 months.…”

“…15 Two phase II studies have recently determined the efficacy of one or more courses of HDCT as intensification after one or more courses of standard-dose induction chemotherapy for poor prognosis GCT patients, as strictly defined by the IGCCCG criteria. [16][17][18] Bokemeyer et al employed one course of standard-dose VIP followed by 3-4 courses of high-dose VIP supported by PBSCs. The overall and event-free survival rates at 2 years were 78 and 73%, respectively.…”

Early prediction of treatment response to high-dose salvage chemotherapy in patients with relapsed germ cell cancer using [18F]FDG PET

“…Since not all patients will benefit to the same amount from this treatment, prognostic scores have been developed in order to identify those patients who are most likely to respond (Beyer et al, 1996) and thus, in whom the physical and financial costs of HD-CTX can be justified (Anthoney and Kaye, 1999;Decartis et al, 2000). It was the aim of the present study to determine whether metabolic monitoring using PET early in the course of salvage chemotherapy can be used to predict the overall response to treatment and indicate the outcome in patients with relapsed germ cell cancer.…”

“…However, HD-CTX is associated with more frequent side effects as well as higher financial costs compared with standard-dose chemotherapy. Thus, it is of great interest, whether one can identify early those patients who will benefit from HD-CTX and those who will not (Anthoney and Kaye, 1999;Decartis et al, 2000).…”