Survival outcomes of patients with germ cell tumors treated with high-dose chemotherapy for refractory or relapsing disease
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Stefanie Zschäbitz1, Florian A Distler2, Benjamin Krieger3, Patrick Wuchter4,6, Kerstin Schäfer-Eckart3, Maximilian Jenzer1, Markus Hohenfellner5, Peter Dreger4, Georg Martin Haag1, Dirk Jäger1, Sascha Pahernik2 and Carsten Grüllich1
1Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, 69120 Heidelberg, Germany
2Department of Urology, Paracelsus Medical University, 90419 Nuremberg, Germany
3Department of Oncology and Hematology, Paracelsus Medical University, 90419 Nuremberg, Germany
4Department of Hematology, Oncology, and Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, Germany
5Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany
6Present address: Institute for Transfusion Medicine and Immunology Mannheim, Medical Faculty Mannheim, University of Heidelberg, DRK-Blutspendedienst Baden-Württemberg–Hessen gGmbH, 68167 Mannheim, Germany
Carsten Grüllich, email: [email protected]
Keywords: autologous stem cell transplantation; high-dose chemotherapy; germ cell tumor; relapse; testicular cancer
Received: January 16, 2018 Accepted: April 04, 2018 Published: April 27, 2018
Introduction: Male patients with metastatic germ cell tumors can be cured in up to 96% of cases depending on stage and IGCCCG prognosis group. Treatment in relapse consists of conventional or high-dose chemotherapy (HDCT) with autologous stem cell transplantation (ASCT) combined with local treatment modalities.
Results: Most patients were classified as poor risk according to IGCCCG (n = 24; 52%) and as intermediate (n = 12), high (n = 16), or very high risk (n = 9) at time of first relapse according to IPFSG criteria. In 67% of patients (n = 31) HDCT/ASCT was performed as first salvage treatment in relapse or for primary refractory disease following first line chemotherapy. In 46% of patients (n = 21) progressive disease was documented after mobilization and prior to HDCT/ASCT. Median progression free survival (mPFS) was 7.4 months (95% confidence interval (CI): 1.3–13.6) while median overall survival (mOS) was 22.2 months (95% CI: 8.9–35.5). When stratified for IPFSG risk group, mPFS (p < 0.001) and mOS (p = 0.009) differed significantly between risk groups (very low vs. low vs. intermediate vs. high vs. very high). Metastases to liver/bone/brain and platinum refractory disease were independent risk factors for inferior PFS (p = 0.024; p = 0.008) but not OS.
Materials and Methods: Forty-six patients treated with HDCT/ASCT at the university clinics in Heidelberg and Nuremberg between 2000–2016 were identified and analyzed. Data was collected retrospectively.
Conclusions: HDCT/ASCT offers a potential curative strategy for patients with relapsed GCT. Improvement is still needed in patients with intermediate, high, and very high IPFSG risk group.
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