SAN FRANCISCO, CA USA (UroToday.com) - Dr. Christian Kollmannsberger reviewed data and indications for stem-cell transplant in germ-cell tumor (GCT) patients.
To answer this question, the effectiveness and toxicity of conventional salvage chemotherapy (CSCT) and high-dose chemotherapy with stem-cell transplant (HDCT-SCT) need to be compared. In order to compare the outcomes of conventional second line versus HDCT-SCT going forward, we need to standardize the patients’ risk based on prognostic factors at the time of relapse. This was done by Lorch, et al. in 2010, when they showed that interval to recurrence, degree of response to first line therapy, primary tumor site, histology of primary tumor, and makers at the time of relapse can assign patients to 1 of 5 risk categories. The historical response rate to CSCT is 30-50% with durable responses approximating 20%. However, this data is mostly retrospective and drawn from heterogenous patient populations.
Two randomized trials have been published which compare HDCT-SCT and CSCT. Neither trial showed that one regimen was superior, although both trials had significant flaws. However, two retrospective trials suggest that HDCT-SCT may perform better. The Indiana series of 184 consecutive patients who had HDCT-SCT had a favorable 63% 4-year disease-free rate. Importantly, many of these patients had aggressive surgical debulking, and there were both favorable and unfavorable risk groups included. A larger retrospective study, evaluating both modalities, showed a benefit for HDCT-SCT across all risk groups after adjustment for known risk factors.
Dr. Kollmannsberger pointed out that the data shows a benefit for 2 or 3 cycles of HDCT-SCT rather than 1 cycle. He closed by suggesting that on the basis of these data, HDCT-SCT should be considered in all patients with platinum-refractory disease at the time of relapse and he stated that the TIGER trial is planned to prospectively evaluate the role of HDCT-SCT in the second-line setting in a more effective manner than the previously published phase III trials.
Highlights of a presentation by Christian Kollmannsberger, MD at the 2014 Genitourinary Cancers Symposium - January 30 - February 1, 2014 - San Francisco Marriott Marquis - San Francisco, California USA
BC Cancer Agency, Vancouver, BC Canada