Role of one, two and three doses of high-dose chemotherapy with autologous transplantation in the treatment of high-risk or relapsed testicular cancer: a systematic review

Abstract

Approximately 20-30% of patients with metastatic germ cell cancers (GCCs) can develop relapsed or refractory (RR) disease, about 40-50% of patients who relapse after salvage chemotherapy may reach long-term remission. The goal of this review was to identify patients who appear to benefit from high-dose chemotherapy (HDCT) and autologous stem cell transplant (ASCT). To access this, we performed a systematic medical literature review to evaluate the effectiveness of HDCT in the frontline setting, as well as in patients with RR testicular cancer. We searched databases for interventional clinical studies and identified 5883 studies. We selected 49 studies for inclusion, which included a total of 5985 patients. Seventeen studies reported results of newly diagnosed poor-risk GCC patients and 32 studies reported results of RR patients. For newly diagnosed patients with poor prognostic predictors, a risk adjusted strategy using unfavorable tumor marker decline with initial standard chemotherapy regimen and upfront HDCT demonstrated improved outcomes. Our data suggest a minimum of two HDCT cycles with ASCT should be standard of care for patients with RR GCC. Failure of HDCT results in a poor prognosis with only 10% of patients achieving lasting remission with salvage therapy.

A nomogram for predicting survival and retroperitoneal lymph node dissection treatment in patients with resected testicular germ cell tumors

“…2 The common treatments for TGCT patients include surgery, chemotherapy, radiotherapy, surveillance, and high-dose chemotherapy with stem cell transplantation. [4][5][6][7] TGCT can usually be cured in patients receiving adjuvant chemotherapy after surgery treatment. 8,9 Appropriate management of TGCT was based on many important factors which include tumor characteristics, sociodemographic variables, and treatment-related factors.…”

“…The common treatments for TGCT patients include surgery, chemotherapy, radiotherapy, surveillance, and high‐dose chemotherapy with stem cell transplantation . TGCT can usually be cured in patients receiving adjuvant chemotherapy after surgery treatment …”

Melphalan, Etoposide, and Carboplatin Megatherapy with Autologous Stem Cell Transplantation in Children with Relapsing or Therapy-Resistant Extracranial Germ-Cell Tumors—A Retrospective Analysis

“…Among the six patients (UPN 2, 4, 7, 8, 12, and 13) without metastatic disease at HDCT, three were not eligible for complete resection (UPN 2, 12, and 13), and the two who underwent ASCT after complete resection eventually relapsed. Among the seven post-pubertal patients, only three are alive ( UPN 5,11,and 18), and the best achievable resection prior to HDCT was not complete. The post-pubertal patients who died of disease (UPN 3, 6, 9, and 15) had inoperable, metastatic disease that progressed after HDCT.…”

“…In adults, 40-50% of relapsing patients may reach long-term remission after salvage chemotherapy, such as TIP (paclitaxel, ifosfamide, and cisplatin) or VeIP (vinblastine, ifosfamide, cisplatin) [10]. The transplant strategy in adults was reviewed by bin Riaz et al, who concluded that a single cycle of HDCT with ASCT does not improve outcomes, but two or three cycles of HDCT improved survival for patients with refractory or relapsed GCT [11]. Early studies of consolidation therapy with HDCT containing carboplatin and etoposide with ASCT were associated with poor outcomes and 20% non-relapse mortality (NRM) [12].…”

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

“…However, this approach has been hampered by early death due to toxicity [ 76 ]. Most of the randomized trials failed to demonstrate significant benefit with HDCT and ASCT in high-risk frontline therapy patient groups [ 77 ]. However, Motzer et al has shown that there was a subset of patients who had intermediate-to-high-risk GCTs with an unsatisfactory tumor marker decline after two cycles of BEP; these patients were switched to two cycles of HDCT and ASCT (carboplatin 600 mg/m 2 , etoposide 600 mg/m 2 , cyclophosphamide 50 mg/kg on day 1, day 2, and day 3, followed by infusion of autologous bone marrow on day 5).…”