Pilot study of a high-dose carboplatin-based salvage strategy for relapsing or refractory germ cell cancer

Eleven patients with germ cell cancer relapsing from a complete remission and 7 patients with refractory germ cell cancer and/or an unresectable partial remission received salvage chemotherapy with one to two courses of carboplatin (800 mg/m2) and etoposide (500 mg/m2 on days 1, 3, and 5), followed by either one or two courses of carboplatin (1600 mg/m2), cyclophosphamide (6 g/m2), and thiotepa (480 mg/m2) divided over 4 days with autologous bone marrow transplantation and/or peripheral stem cell support. Eight of 11 relapsing patients (73%) were salvaged (with a follow-up of 21+ to 56+ months), but only 1 of the 7 refractory patients survived (34+ months). The high-dose carboplatin-based salvage regimen is feasible and deserves further evaluation in patients relapsing from a complete remission. Even more intensive treatment strategies may be required to salvage patients who are refractory to standard doses of platinating agents.