High-dose chemotherapy in germ-cell tumors

Area of Science:

• Oncology
• Hematology
• Pharmacology

Background:

• Advanced-stage germ-cell tumors (GCTs) are often curable with cisplatin-based chemotherapy, but relapse occurs in 10-50% of patients.
• Patients experiencing first relapse have a limited chance (15-25%) of durable remission with standard salvage therapies.

Purpose of the Study:

• To evaluate the efficacy and role of high-dose chemotherapy (HDC) with hematopoietic stem-cell support in patients with relapsed or refractory GCTs.
• To identify prognostic factors influencing outcomes after HDC in GCT patients.

Main Methods:

• Review of reported cases (n=436) of salvage HDC, primarily using etoposide, cyclophosphamide, ifosfamide, and carboplatin or cisplatin.
• Analysis of prognostic factors including disease status, primary tumor site, prior chemotherapy response, and serum hCG levels.
• Mention of ongoing randomized trials comparing HDC to standard salvage treatment and evaluating HDC in first-line consolidation for poor-risk GCTs.

Main Results:

• Overall, 22% of patients receiving salvage HDC achieved long-term complete remission.
• Patients with sensitive disease and no adverse prognostic factors had >50% chance of cure with HDC.
• Patients with refractory disease did not benefit from HDC.

Conclusions:

• High-dose chemotherapy can lead to long-term remission in a subset of relapsed GCT patients, especially those with sensitive disease.
• Prognostic factors are crucial for patient selection for HDC.
• Ongoing trials aim to further define the role of HDC in both salvage and first-line settings, with new agents being investigated.