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A review of second-line chemotherapy and prognostic models for disseminated germ cell tumors
Martin H Voss1, Darren R Feldman, George J Bosl
1Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Abstract:
Despite an excellent prognosis even for patients with disseminated disease, about 20% to 30% of men with advanced germ cell tumors are refractory to first-line chemotherapy or experience disease recurrence after an initial remission with such treatment. Many of these are cured with conventional dose cisplatin/ifosfamide-based regimen or high-dose chemotherapy with stem cell rescue. Controversy exists regarding the optimal choice between these 2 second-line approaches, and available data for each is reviewed here. Clinical factors can help prognosticate patients, and recently an international effort developed a prognostic model for the second-line setting that can be universally applied in future studies.
Insights
About 20-30% of men with advanced germ cell tumors need second-line chemotherapy due to resistance or recurrence. This review examines conventional versus high-dose chemotherapy options for these patients.
Area of Science:
- Oncology
- Medical Chemotherapy
- Clinical Research
Background:
- Advanced germ cell tumors (GCTs) have a generally good prognosis, but 20-30% of patients exhibit resistance to initial chemotherapy or relapse.
- Treatment resistance and recurrence in GCTs necessitate effective second-line therapeutic strategies.
Purpose of the Study:
- To review and compare the efficacy of conventional-dose cisplatin/ifosfamide-based regimens versus high-dose chemotherapy with stem cell rescue as second-line treatments for advanced germ cell tumors.
- To discuss the existing controversy surrounding the optimal choice between these two second-line approaches.
Main Methods:
- Literature review of available data on conventional-dose and high-dose chemotherapy for refractory or relapsed germ cell tumors.
- Analysis of clinical factors influencing prognosis in the second-line setting.
Main Results:
- Many patients with refractory or relapsed GCTs can be cured with either conventional-dose or high-dose chemotherapy regimens.
- An international effort has recently developed a universally applicable prognostic model for the second-line treatment of GCTs.
Conclusions:
- The optimal second-line treatment strategy for advanced germ cell tumors remains a subject of ongoing debate.
- Clinical prognostic factors are crucial for guiding treatment decisions, and a new prognostic model aids in future research and patient management.
