ASCO GU 2018: High-Dose Chemotherapy and Stem-Cell Rescue - Salvage Treatment for Germ Cell Testicular Tumors in Second- and Third-Line, and Outside Clinical Trials

San Francisco, CA (UroToday.com) Dr. Fernanda Ronchi and colleagues from Brazil provided results of their experience with high-dose chemotherapy and stem-cell rescue as salvage treatment among men with germ cell testicular tumors. Testicular tumors are the most common cancer in young males, usually curable in early stages. Therefore, only 25% of relapsed patients are long-term survivors. Previous non-randomized studies showed promising results with high-dose chemotherapy, however, the only randomized trial did not support this approach [1]. The objective of this study was to report the real-world use of high-dose chemotherapy and stem cell rescue in the second- and third-line at a Brazilian institution. 

For this study, a retrospective review of all consecutive patients treated with salvage high-dose chemotherapy followed by stem-cell transplantation (1996 – 2016) was performed. Survival curves were estimated by Kaplan-Maier method. Prognostic factors were determined by Cox regression model. There were 36 eligible patients among which the median follow-up was 56 months. At 2 years 50.4% of the patients were alive, and 46.7% were disease-free. The median overall survival (OS) was not-reached and the median progression-free survival (PFS) was 21.8 months. The overall response-rate was 61.2% (22% had complete response and 39% had partial response). All patients who achieved complete response were alive at the last follow-up, and only one had progressive disease. Out of the patients who achieved partial response, one third were rescued with surgery (46% teratoma, 23% fibrosis, and 31% residual disease), and 80% were alive at 2 years follow-up. Complete response (vs. others) and high dose chemotherapy as second line treatment (vs. 3rd and 4th) were good prognostic factors. In 2 years, the OS in patients treated in the 2nd line was approximately 80%, 50% for 3rd line, and 0% of those treated in 4th line. 89% of the patients experienced grade 3 toxicity, and 25% grade 4 toxicity. The most common were neutropenic fever (69%), mucositis (36%) and diarrhea (25%); there were 3 deaths related to the treatment.

The authors concluded that in a single center retrospective analysis, patients with complete response to high-dose chemotherapy with stem cell transplant have sustained long-term survival, and represent the subgroup with clear treatment benefit. When feasible, surgery can rescue 80% of the patients with partial response. According to this data, the authors do not recommend high-dose chemotherapy in 4th line setting.


Presented by:  Fernanda Carneiro Ronchi, BA, A.C. Camargo Cancer Center, São Paulo, Brazil

Co-Authors: Daniel Vilarim Araujo, Ana Claudia Machado Urvanegia, José Augusto Rinck; A.C. Camargo Cancer Center, São Paulo, Brazil; University of Campinas, Campinas, Brazil

Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, @zklaassen_md at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA

References: 

1. Daugaard G, Skoneczna I, Aass N, et al. A randomized phase III study comparing standard dose BEP with sequential high-dose cisplatin, etoposide, and ifosfamid (VIP) plus stem-cell support in mlaes with poor-prognosis germ cell cancer. An intergroup study of EORTC, GTCSG, and Grup Germinal (EORTC 30974). Ann Oncol 2011;22(5):1054-1061.
E-Newsletters

Newsletter subscription

Free Daily and Weekly newsletters offered by content of interest

The fields of GU Oncology and Urology are rapidly advancing. Sign up today for articles, videos, conference highlights and abstracts from peer-review publications by disease and condition delivered to your inbox and read on the go.

Subscribe