Second-Line Chemotherapy in Patients With Relapsed Extragonadal Nonseminomatous Germ Cell Tumors: Results of an International Multicenter Analysis

Abstract

Although current salvage strategies will cure between 20% and 50% of recurrent metastatic testicular cancer, relapsed nonseminomatous EGGCT patients appear to have an inferior survival rate, in particular in case of primary mediastinal location. Mediastinal primary tumor and inadequate response to cisplatin-based induction chemotherapy have been identified as independent negative prognostic factors, both associated with an approximately two-fold higher risk for failure of salvage treatment.

Long-term follow-up of patients undergoing auto-SCT for advanced germ cell tumour: a multicentre cohort study

“…This finding is consistent with previous studies. 4,8,9,14,18,19 In addition, in those presenting with primary mediastinal disease, auto-SCT was associated with relatively poor OS and EFS. A large review of patients published in 1996 by Beyer et al 20 had no long-term survivors after auto-SCT in patients with primary mediastinal presentation.…”

“…In addition, IGCCC disease risk at presentation was predictive of OS and EFS, as has been previously reported. 4,9,18,20 The majority of relapses occurred within 1 year. However, there were two very late relapses (11 and 13 years after auto-SCT).…”

First-line high-dose chemotherapy for patients with poor prognosis extragonadal germ cell tumors: the experience of the European Bone Marrow Transplantation (EBMT) Solid Tumors Working Party

“…In patients who achieve only a partial remission with positive serum tumor marker after induction therapy, some authors consider HDCT as initial salvage, rather than late intensification of initial therapy. 13 In accordance with these authors, we analyzed patients receiving HDCT after achieving complete remission or partial remission with negative tumor marker after induction therapy. Of all these patients, 23 were treated with HDCT as first-line setting.…”

First-line sequential high-dose VIP chemotherapy with autologous transplantation for patients with primary mediastinal nonseminomatous germ cell tumours: a prospective trial

“…Accordingly, the presence of a mediastinal primary tumour in patients with nonseminomatous GCT was identified as a major adverse prognostic factor by the IGCCCG. Such patients appear to represent a clinically and biologically distinct disease entity (Nichols et al, 1985(Nichols et al, , 1987(Nichols et al, , 1990aHartmann et al, 2000b, (Saxman et al, 1994, Loehrer et al, 1998Hartmann et al, 2001a). Historically, the incorporation of cisplatin into chemotherapy regimens has yielded survival rates of approximately 30 -40% in retrospective analyses (Garnick et al, 1983;Logothetis et al, 1985;Delgado et al, 1993;Dulmet et al, 1993;Toner et al, 1991; International germ cell consensus classification, 1997).…”