High-Dose Chemotherapy and Stem-Cell Rescue for Metastatic Germ-Cell Tumors

TLDR

Metastatic testicular tumors refractory to initial cisplatin‑based chemotherapy may still be curable with salvage high‑dose chemotherapy, as shown in a retrospective review of 184 patients. The regimen involved two consecutive 3‑day courses of high‑dose carboplatin (700 mg/m²) and etoposide (750 mg/m²) followed by autologous peripheral‑blood stem‑cell rescue, with 11 patients receiving a single course. Among 184 patients, 116 achieved durable complete remission (median 48 months), with 94/135 second‑line, 22/49 third‑line, 18/40 platinum‑refractory, 98/144 platinum‑sensitive, 26/35 seminoma, and 90/149 non‑seminomatous patients disease‑free; however, 3 drug‑related deaths and 3 post‑therapy acute leukemias occurred.

Abstract

Metastatic testicular tumors that have not been successfully treated by means of initial chemotherapy are potentially curable with salvage chemotherapy.We conducted a retrospective review of 184 consecutive patients with metastatic testicular cancer that had progressed after they received cisplatin-containing combination chemotherapy. We gave 173 patients two consecutive courses of high-dose chemotherapy consisting of 700 mg of carboplatin per square meter of body-surface area and 750 mg of etoposide per square meter, each for 3 consecutive days, and each followed by an infusion of autologous peripheral-blood hematopoietic stem cells; the other 11 patients received a single course of this treatment. In 110 patients, cytoreduction with one or two courses of vinblastine plus ifosfamide plus cisplatin preceded the high-dose chemotherapy.Of the 184 patients, 116 had complete remission of disease without relapse during a median follow-up of 48 months (range, 14 to 118). Of the 135 patients who received the treatment as second-line therapy, 94 were disease-free during follow-up; 22 of 49 patients who received treatment as third-line or later therapy were disease-free. Of 40 patients with cancer that was refractory to standard-dose platinum, 18 were disease-free. A total of 98 of 144 patients who had platinum-sensitive disease were disease-free, and 26 of 35 patients with seminoma and 90 of 149 patients with nonseminomatous germ-cell tumors were disease-free. Among the 184 patients, there were three drug-related deaths during therapy. Acute leukemia developed in three additional patients after therapy.Testicular tumors are potentially curable by means of high-dose chemotherapy plus hematopoietic stem-cell rescue, even when this regimen is used as third-line or later therapy or in patients with platinum-refractory disease.