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.
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