A Single Center Review of Patients Undergoing High-Dose Chemotherapy for Relapsed Germ-Cell Tumors

Germ cell tumors (GCTs) are the most significant cause of cancer-related morbidity and mortality among young males. High-dose chemotherapy (HDCT) has become an important component of the management of relapsed metastatic GCTs. The preferred HDCT regimen has changed over time, and the efficacy of these regimens has not been directly compared.

A retrospective case series of patients from 1997 to 2018 at a single center was analyzed for baseline characteristics, treatment regimen, and outcomes.

Twenty-two patients received HDCT at this institution. Seven patients received conditioning with ifosfamide-carboplatin-etoposide (ICE), 10 patients received carboplatin-etoposide (CE), and five received other regimens, including busulfan-cyclophosphamide. Patients receiving ICE had a higher median International Prognostic Factor Study Group prognostic score compared to CE and the other regimens (3.0 vs. 1.5 vs. 2.0). Duration of admission was shorter with CE compared with ICE and the other regimens (21 days vs. 29 days vs. 28 days). Duration of neutropenia was shorter with CE and ICE compared with the other regimens (11 days vs. 12 days vs. 16.5 days). ICE was associated with a higher 12-month relapse-free survival (RFS) (71.4% vs. 40.0%) and 36-month overall survival (OS) (71.4% vs. 25.0%) than CE.

At this institution, patients receiving ICE as a conditioning regimen before autologous stem cell rescue appear to have a longer RFS and higher OS than those receiving CE. We consider the use of CE alone as a conditioning regimen to be inadequate, which supports our adoption of the more intense paclitaxel, ifosfamide-carboplatin, etoposide regimen as our standard.