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Comparison of three or fewer high-dose chemotherapy cycles as salvage treatment in germ cell tumors in first relapse

Bone Marrow Transplantation volume 52, pages 334–336 (2017)Cite this article

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Unique characteristics discriminate germ cell tumors (GCTs) from other solid malignancies. Patients are predominantly young men between 15 and 40 years with few comorbidities (if any); tumors are particularly sensitive to platinum-based chemotherapy; and a cure is still possible with salvage approaches in patients with progression after first-line chemotherapy. Curative salvage strategies involve conventional-dose chemotherapy (CDCT) or, alternatively, high-dose chemotherapy with autologous stem cell transplantation (HDCT/ASCT), which—in contrast to virtually all other types of solid tumors—can be highly effective.1, 2, 3, 4, 5, 6, 7, 8, 9, 10

A retrospective analysis of 1594 patients undergoing initial salvage chemotherapy found better outcomes for patients who received sequential HDCT cycles compared with single-cycle HDCT.11, 12 Additional reports have demonstrated excellent outcomes with regimens consisting of both two or three HDCT cycles.2, 10, 11, 13, 14 When comparing single versus tandem autotransplants for relapsed GCT patients in an intention-to-treat analysis, no differences in 5-year PFS and overall survival (OS) were reported between two carboplatin/etoposide (CE)-based HDCT/ASCT cycles versus treatment with a single cycle of HDCT.15 However, the optimum number of CE-HDCT cycles with ASCT for relapsed GCT patients remains to be established in prospective studies.

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Acknowledgements

We thank Helen Baldomero, Irene Briner and Doris Jaeggi-Meinken for their generous help with the data collection, and Martin Bigler (statistician, SAKK) for assistance with the statistical analysis. This work was supported by grants from the Bernische Stiftung für Klinische Krebsforschung (to TP), from the Krebsliga Bern (to TP) and from the EMPIRIS Foundation/Ursula-Hecht-Fonds (to TP).

Author contributions

FG: performed the research, analyzed the data and wrote the paper; MS, MZ and JS: contributed vital material, analyzed the data and reviewed the paper; SP, AM, FS, UH, DB and MB: contributed vital material and reviewed the paper; TP: designed the research, analyzed the data and wrote the paper.

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Authors and Affiliations

  1. Department of Medical Oncology, University Hospital Bern, Bern, Switzerland

    F Gössi, M Zweifel, J Schardt & T Pabst

  2. Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

    M Spahn

  3. Department of Oncology, University Hospital Zurich, Zurich, Switzerland

    S Panagiotis & A Mischo

  4. Department of Oncology, University Hospital Basel, Basel, Switzerland

    F Stenner

  5. Department of Oncology, Kantonsspital St Gallen, St Gallen, Switzerland

    U Hess

  6. Department of Oncology, CHUV University Hospital Lausanne, Lausanne, Switzerland

    D Berthold

  7. Department of Hematology,

    M Bargetzi

  8. Kantonsspital Aarau, Aarau, Switzerland

    M Bargetzi

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  1. F Gössi
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Correspondence to T Pabst.

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Gössi, F., Spahn, M., Zweifel, M. et al. Comparison of three or fewer high-dose chemotherapy cycles as salvage treatment in germ cell tumors in first relapse. Bone Marrow Transplant 52, 334–336 (2017). https://doi.org/10.1038/bmt.2016.285

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