Survival outcomes of patients with germ cell tumors treated with high-dose chemotherapy for refractory or relapsing disease

Male patients with metastatic germ cell tumors can be cured in up to 96% of cases depending on stage and IGCCCG prognosis group. Treatment in relapse consists of conventional or high-dose chemotherapy (HDCT) with autologous stem cell transplantation (ASCT) combined with local treatment modalities.

Most patients were classified as poor risk according to IGCCCG (n = 24; 52%) and as intermediate (n = 12), high (n = 16), or very high risk (n = 9) at time of first relapse according to IPFSG criteria. In 67% of patients (n = 31) HDCT/ASCT was performed as first salvage treatment in relapse or for primary refractory disease following first line chemotherapy. In 46% of patients (n = 21) progressive disease was documented after mobilization and prior to HDCT/ASCT. Median progression free survival (mPFS) was 7.4 months (95% confidence interval (CI): 1.3-13.6) while median overall survival (mOS) was 22.2 months (95% CI: 8.9-35.5). When stratified for IPFSG risk group, mPFS (p < 0.001) and mOS (p = 0.009) differed significantly between risk groups (very low vs. low vs. intermediate vs. high vs. very high). Metastases to liver/bone/brain and platinum refractory disease were independent risk factors for inferior PFS (p = 0.024; p = 0.008) but not OS.

Forty-six patients treated with HDCT/ASCT at the university clinics in Heidelberg and Nuremberg between 2000-2016 were identified and analyzed. Data was collected retrospectively.

HDCT/ASCT offers a potential curative strategy for patients with relapsed GCT. Improvement is still needed in patients with intermediate, high, and very high IPFSG risk group.

Oncotarget. 2018 Apr 27*** epublish ***

Stefanie Zschäbitz, Florian A Distler, Benjamin Krieger, Patrick Wuchter, Kerstin Schäfer-Eckart, Maximilian Jenzer, Markus Hohenfellner, Peter Dreger, Georg Martin Haag, Dirk Jäger, Sascha Pahernik, Carsten Grüllich

Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, 69120 Heidelberg, Germany., Department of Urology, Paracelsus Medical University, 90419 Nuremberg, Germany., Department of Oncology and Hematology, Paracelsus Medical University, 90419 Nuremberg, Germany., Department of Hematology, Oncology, and Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, Germany., Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany.

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