Paclitaxel-containing high-dose chemotherapy for relapsed or refractory testicular germ cell tumours

Abstract

High-dose regimes containing etoposide, carboplatin and an oxazaphospharine can salvage 30 -40% of patients with relapsed or refractory male germ cell tumours (GCTs). The additional benefit of paclitaxel in such high-dose therapy has not been tested. Between March 1995 and November 2002, 36 male GCT patients were treated with Carbop-EC-T (paclitaxel 75 mg m À2 , etoposide 450 mg m À2 , carboplatin AUC 10 on days À7, À5 and À3 and cyclophosphamide 60 mg kg À1 on days À5 and À3) followed by peripheral blood stem cell infusion (day 0). The 1-year overall survival rate for all patients is 67% (median follow-up 29 months). For the 24 patients with cisplatin-sensitive disease, the 1-year overall and event-free survivals are 88 and 64%, respectively. For those with cisplatin refractory or absolutely refractory disease, the 1-year overall survival is 25%. In all, 12 patients relapsed at a median duration of 5 months, 11 of whom have died. There were also six treatment-related deaths, five associated with pneumonitis. Pulmonary toxicity has been reported with paclitaxel in other high-dose regimes. Since altering our protocol so that paclitaxel is infused over 24 h with steroid prophylaxis, only one of 18 patients (13 testicular GCTs and five other tumour types) has had a treatment-related death. Our results suggest that Carbop-EC-T may enable a greater proportion of patients with relapsed and refractory GCTs to enter long-term remission.

Long-term follow-up of patients undergoing auto-SCT for advanced germ cell tumour: a multicentre cohort study

“…This finding is consistent with previous studies. 4,8,9,14,18,19 In addition, in those presenting with primary mediastinal disease, auto-SCT was associated with relatively poor OS and EFS. A large review of patients published in 1996 by Beyer et al 20 had no long-term survivors after auto-SCT in patients with primary mediastinal presentation.…”

“…In addition, IGCCC disease risk at presentation was predictive of OS and EFS, as has been previously reported. 4,9,18,20 The majority of relapses occurred within 1 year. However, there were two very late relapses (11 and 13 years after auto-SCT).…”

“…4,[12][13][14][15] A summary of the results of the larger studies, in which the majority of patients received auto-SCT for relapsed GCT, is shown in Table 4. Previous studies have demonstrated an OS of between 25 4 and 57%.…”

“…Several non-randomized studies have examined the role of high-dose chemotherapy with autologous blood or marrow transplantation in the salvage setting (auto-SCT). [2][3][4][5] These studies suggest that auto-SCT can induce CR and prolonged disease-free survival. 2,6,7 One randomized controlled trial comparing standard salvage chemotherapy with auto-SCT showed no significant benefit from auto-SCT.…”

Management of Recurrent Testicular Germ Cell Tumors

“…The British Imperial College School of Medicine treated 36 men with GCTs with three cycles of conventional chemotherapy followed by one cycle of paclitaxel in addition to high-dose etoposide, carboplatin, and cyclophosphamide with peripheral stem cell infusion [55]. The 1-year overall survival rate for all patients was 67%, with a median follow-up of 29 months.…”