Is High Dose Therapy Superior to Conventional Dose Therapy as Initial Treatment for Relapsed Germ Cell Tumors? The TIGER Trial

Feldman, Darren R.; Huddart, Robert; Hall, Emma; Beyer, Jörg; Powles, Thomas

doi:10.7150/jca.2.374

Cited by 50 publications

(31 citation statements)

References 10 publications

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“…Outside a clinical trial, patients may be treated with conventional-dose chemotherapy or HD-CT depending on the presence or absence of adverse prognostic factors, availability of resources, and patient as well as physician preferences. The international prospective phase III trial TIGER (NCT02375204) will provide high evidence to finally answer the question of whether or not, and in which patients, HD-CT as first salvage treatment is superior to conventional treatment [36]. Hence, all patients should be included in this trial as soon as it opens for recruitment at German centers.…”

Section: Resultsmentioning

confidence: 99%

The Role of Salvage High-Dose Chemotherapy in Relapsed Male Germ Cell Tumors

Oing

Lorch

2018

Oncol Res Treat

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Germ cell tumors (GCT) are a unique tumor entity with excellent cure rates if guideline-endorsed treatment is thoroughly applied. Even patients with widespread metastatic disease can often be cured with cisplatin-based combination chemotherapy as part of a multimodal treatment approach. However, about 30% of patients with metastatic disease at initial presentation, corresponding to about 5-10% of all GCT patients, relapse or progress despite first-line treatment and therefore require salvage chemotherapy. Salvage systemic treatment either consists of conventional-dose cisplatin-based combination chemotherapy or sequential high-dose treatment with carboplatin and etoposide plus subsequent autologous stem cell support. This review is based on a comprehensive literature search of MEDLINE and conference proceedings of ESMO, ASCO, and EAU meetings until 2018 and provides an overview of current treatment options for germ cell cancer patients relapsing after or progressing during first-line cisplatin-based combination chemotherapy.

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Section: Resultsmentioning

confidence: 99%

The Role of Salvage High-Dose Chemotherapy in Relapsed Male Germ Cell Tumors

Oing

Lorch

2018

Oncol Res Treat

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“…Salvage chemotherapy with the two main components cisplatin (P) and ifosfamide (I) serves as a backbone, and combines a variety of other agents such as etoposide (VIP), vinblastine (VeIP), paclitaxel (TIP), or gemcitabine (GIP) [7••]. In relapsed or refractory GCT, dose escalation using high-dose chemotherapy (HDCT) with autologous stem cell support has been promising in phase II studies as well as in retrospective comparisons and may improve survival [8]. More recently, combinations like gemcitabine, oxaliplatin, and paclitaxel (GOP) or the use of the new agent palifosfamide have also been reported (see Table 1).…”

Section: Current Chemotherapy Approaches To Advanced Diseasementioning

confidence: 99%

Emerging Therapeutic Targets for Male Germ Cell Tumors

et al. 2015

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Male germ cell tumors (GCTs) are curable cancers, yet 10-15 % of patients with metastatic disease fail cisplatin-based first-line treatments. While therapeutic options have increased for various other cancers, little progress has been made in the management of GCT in the last decades. A better understanding of the molecular alterations underlying the disease and identification of new therapeutic targets are needed. Several phase I/II studies with promising new agents are ongoing or have been completed, but most of those trials have been small and have not included translational research. Therefore, molecular profiles predictive for response or new agents have not been identified in male GCT so far. The purpose of this review is to highlight emerging targets and therapies with the potential to improve systemic treatment of metastatic male GCT and to develop strategies for future clinical trials.

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“…However, even in this setting, the superiority of high doses over conventional chemotherapy as the first salvage treatment is still debated and a randomized phase III trial is in progress to address this issue [33]. …”

Section: Discussionmentioning

confidence: 99%

A Phase I Trial of High-Dose Chemotherapy Combining Topotecan plus Cyclophosphamide with Hematopoietic Stem Cell Transplantation for Ovarian Cancer: The ITOV 01bis Study

et al. 2015

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Background: Dose-intensive chemotherapy with hematopoietic stem cell transplantation has been evaluated as a salvage treatment for recurrent ovarian cancer, but its benefit has not yet been demonstrated. In a previous phase I trial, we reported the feasibility of administering topotecan as a salvage regimen. Methods: Twenty-one patients were treated with escalating doses of topotecan associated with a fixed dose of cyclophosphamide. Results: The maximum tolerated dose was established at 9.0 mg/m² on a 5-day regimen, analogously to what was reported for topotecan monotherapy. One toxic death from septic shock and multiorgan failure occurred. Although hematopoietic toxicities were overcome by peripheral blood stem cell transplantation, superior nonhematological toxicities were observed as compared to the initial trial. Conclusion: Response rates were generally short and survival rates were poor. Results of the ITOV 01bis study demonstrate that, in the setting of recurrent ovarian cancer, intensive chemotherapy based on topotecan-cyclophosphamide association is not currently clinically indicated.

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Is High Dose Therapy Superior to Conventional Dose Therapy as Initial Treatment for Relapsed Germ Cell Tumors? The TIGER Trial

Cited by 50 publications

References 10 publications

The Role of Salvage High-Dose Chemotherapy in Relapsed Male Germ Cell Tumors

The Role of Salvage High-Dose Chemotherapy in Relapsed Male Germ Cell Tumors

Emerging Therapeutic Targets for Male Germ Cell Tumors

A Phase I Trial of High-Dose Chemotherapy Combining Topotecan plus Cyclophosphamide with Hematopoietic Stem Cell Transplantation for Ovarian Cancer: The ITOV 01bis Study

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