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High-dose chemotherapy and stem-cell rescue for metastatic germ-cell tumors Einhorn LH; Williams SD; Chamness A; Brames MJ; Perkins SM; Abonour RN Engl J Med 2007[Jul]; 357 (4): 340-8BACKGROUND: Metastatic testicular tumors that have not been successfully treated by means of initial chemotherapy are potentially curable with salvage chemotherapy. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.|*Hematopoietic Stem Cell Transplantation[MESH]|*Salvage Therapy[MESH]|Adolescent[MESH]|Adult[MESH]|Algorithms[MESH]|Antineoplastic Combined Chemotherapy Protocols/*therapeutic use[MESH]|Cisplatin/administration & dosage[MESH]|Combined Modality Therapy[MESH]|Etoposide/administration & dosage[MESH]|Follow-Up Studies[MESH]|Humans[MESH]|Male[MESH]|Middle Aged[MESH]|Neoplasm Recurrence, Local/drug therapy/therapy[MESH]|Neoplasms, Germ Cell and Embryonal/*drug therapy/mortality/secondary/therapy[MESH]|Prognosis[MESH]|Proportional Hazards Models[MESH]|Remission Induction[MESH]|Retrospective Studies[MESH]|Survival Analysis[MESH]|Testicular Neoplasms/*drug therapy/mortality/pathology/therapy[MESH] |
