ISSN:
1569-8041
Keywords:
cisplatin-refractory patients
;
germ cell cancer
;
ifosfamide
;
paclitaxel
;
post-HDCT chemotherapy
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract Background: In most patients with advanced refractory germ cell tumorsundergoing high-dose chemotherapy with stem cell support (HDCT) the diseaseprogresses after HDCT. This study was designed to shed light on theunestablished role of post-HDCT chemotherapy. Patients and methods: In a retrospective multicenter study data of 47evaluable patients from nine centers subjected to post-HDCT chemotherapy forprogression of their germ cell tumors were collected in a questionnairesurvey and analyzed for treatment response and survival. Results: Of 191 patients pretreated by HDCT, 48 (25%) weresubjected to post-HDCT chemotherapy for disease progression. Remission wasachieved in 17 (36%) and marker-negative remission in eight(17%). The median survival time was 26 weeks, 65 weeks for respondersand 13 weeks for non-responders. Only one of 47 evaluable patients achievedsustained complete remission. Remissions significantly correlated with thepost-HDCT interval, the use of ifosfamide and the combination regimens ofcisplatin + etoposide i.v. or ifosfamide and of paclitaxel + ifosfamide orcisplatin. On univariate analysis a longer post-HDCT interval, the use ofcisplatin, paclitaxel and ifosfamide and the combined use of paclitaxel +ifosfamide and/or cisplatin significantly improved the chances of survival.On multivariate analysis only treatment with paclitaxel and ifosfamideretained independent prognostic significance for survival. Conclusions: One third of the patients considered to be candidates forfurther chemotherapy once progressive after HDCT went into remission with again in survival time. Sustained remissions may occur, but are rarely seen.Paclitaxel and ifosfamide appear to be the most effective drugs in theseheavily pretreated patients.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1023/A:1008286305312
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