Salvage, dose intense and high-dose chemotherapy for the treatment of poor prognosis or recurrent germ cell tumours

Summary 

Most patients with metastatic testicular cancer are cured with cisplatin-based chemotherapy regimens. However, about 20–30% of patients with poor-risk germ cell tumours either fail to respond adequately or relapse after initial complete response.

In an attempt to improve the treatment results, several phase II studies of high-dose chemotherapy (HDCT) and haematopoeitic stem cell support were performed initially in refractory or heavily pre-treated patients with germ cell tumours (GCT). Long-term disease-free survival (DFS) has been reported in nearly 13% (range 0–35%) of the patients in this group. Subsequently, HDCT trials have been conducted in first relapse; long-term DFS has been seen in 45% of the patients in these trials (range 21–67%). HDCT has also been evaluated in the first-line treatment of poor-risk GCTs; long-term DFS was achieved in 52% of the patients in this group (range 36–84%).

Despite these encouraging results, a French randomised trial has failed to demonstrate any advantage of HDCT in the first-line treatment of poor-risk GCTs and thus the place of HDCT in routine practice remains uncertain. A number of randomised trials of HDCT are currently ongoing in the United States and Europe to better define the role of HDCT in this disease.

Keywords: Germ cell tumours, High-dose chemotherapy, Autologous stem cell, Bone marrow transplantation