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McHugh DJ, Gleeson JP, Feldman DR. Testicular cancer in 2023: Current status and recent progress. CA Cancer J Clin 2024; 74:167-186. [PMID: 37947355 DOI: 10.3322/caac.21819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 11/12/2023] Open
Abstract
Testicular germ cell tumor (GCT) is the most common solid tumor in adolescent and young adult men. Progress in the management of GCT has been made in the last 50 years, with a substantial improvement in cure rates for advanced disease, from 25% in the 1970s to nearly 80%. However, relapsed or platinum-refractory disease occurs in a proportion, 20% of whom will die from disease progression. This article reviews the current evidence-based treatments for extracranial GCT, the acute and chronic toxic effects that may result, and highlights contemporary advances and progress in the field.
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Affiliation(s)
- Deaglan J McHugh
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medicine, New York, New York, USA
| | - Jack P Gleeson
- Cancer Research, College of Medicine and Health, University College Cork, Cork, Ireland
- Medical Oncology Department, Cork University Hospital, Cork, Ireland
| | - Darren R Feldman
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medicine, New York, New York, USA
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2
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Funt SA, Knezevic A, Wilson K, Bromberg M, Budnick A, O'Connor KL, McHugh DJ, Larsen E, Bajorin DF, Motzer RJ, Tonorezos ES, Patil S, Feldman DR. Ototoxicity associated with high-dose carboplatin for patients with previously treated germ cell tumors. Cancer 2023; 129:3952-3961. [PMID: 37715631 DOI: 10.1002/cncr.34991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/26/2023] [Accepted: 07/18/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND High-dose carboplatin is an essential part of curative high-dose chemotherapy (HDCT) for patients with previously treated germ cell tumors (GCTs). Although hearing loss (HL) is a known side effect of HDCT, data on its severity and characteristics are limited. METHODS Eligible patients received HDCT for GCTs from 1993 to 2017 and had audiograms before and after HDCT. HL severity was classified by American Speech-Language-Hearing Association criteria, and mean change in hearing threshold at each frequency (0.25-8 kHz) was estimated from pre- to post-HDCT and between HDCT cycles. RESULTS Of 115 patients (median age, 32 years), 102 (89%) received three cycles of HDCT. Of 106 patients with normal hearing to mild HL in the speech frequencies (0.5-4 kHz) before HDCT, 70 (66%) developed moderate to profound HL in the speech frequencies after HDCT. Twenty-five patients (22%) were recommended for hearing aids after HDCT. Patients with moderate to profound HL isolated to the higher frequencies (6-8 kHz) before HDCT were more likely to develop moderate to profound HL in the speech frequencies after HDCT (94% vs. 61%; p = .01) and to be recommended for hearing aids (39% vs. 18%; p = .05). CONCLUSIONS HL was frequent after HDCT for GCTs, with most patients developing at least moderate HL in the speech frequencies and approximately one in five recommended for hearing aids. Moderate to profound HL isolated to high frequencies at baseline was predictive of more clinically significant hearing impairment after HDCT. PLAIN LANGUAGE SUMMARY Some patients with germ cell tumors, the most common malignancy in adolescent and young adult men, are not cured with standard-dose chemotherapy and require high-dose chemotherapy (HDCT). Using detailed hearing assessments of patients receiving HDCT, we found that most patients developed significant hearing loss and that one in five needed hearing aids. Thus, strategies to reduce this side effect are urgently needed, and all patients receiving HDCT should have a hearing test after therapy.
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Affiliation(s)
- Samuel A Funt
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| | - Andrea Knezevic
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kaamilah Wilson
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Maria Bromberg
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Amy Budnick
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kerri L O'Connor
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Deaglan J McHugh
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| | - Erik Larsen
- Formerly of Decibel Therapeutics, Boston, Massachusetts, USA
| | - Dean F Bajorin
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| | - Robert J Motzer
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| | | | - Sujata Patil
- Department of Biostatistics, Cleveland Clinic, Cleveland, Ohio, USA
| | - Darren R Feldman
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
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3
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Wang Z, Li B, Xing J, Gong Z, Xu A, Wang Z. Causes of death after testicular cancer diagnosis: a US population-based analysis. BMC Urol 2023; 23:144. [PMID: 37660082 PMCID: PMC10475185 DOI: 10.1186/s12894-023-01309-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/10/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND After the introduction of cisplatin-based chemotherapy, the survival time of testicular cancer (TC) patients has improved dramatically. However, the overall risk of death in patients with TC remains significantly higher than in the general population. The aim of this study was to assess and quantify the causes of death after TC diagnosis. METHOD In total, 44,975 men with TC in the United States diagnosed and registered by the Surveillance, Epidemiology, and End Results (SEER) database during 2000 to 2018 were studied. In this study, standardized mortality rates (SMRs) were calculated for each cause of death in TC individuals and further analyzed in strata according to age and race. RESULT Of the included participants, 3,573 (7.94%) died during the follow-up period. The greatest proportion of deaths (38.20%) occurred within 1 to 5 years after diagnosis. Most deaths occurred from TC itself and other cancers. For non-malignant conditions, the most common causes of death within 1 years after diagnosis were accidents and adverse effects (53, 4.75%) followed by diseases of heart (45, 4.04%). However, > 1 years after diagnosis, the most common noncancer causes of death were heart diseases. Results of stratified analysis show that non-Hispanic White TC participants have a lower SMR (0.68, 95% CI, 33.39-38.67) from Cerebrovascular Diseases than the general U.S. POPULATION CONCLUSIONS Although TC remains the most common cause of death after TC diagnosis, other non-TC causes of death represent a significant number of deaths among TC men. These findings help TC survivors understand the various health risks that may occur at different follow-up periods.
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Affiliation(s)
- Zhongyuan Wang
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Street, Nanjing, 210029, Jiangsu Province, China
| | - Baochao Li
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Street, Nanjing, 210029, Jiangsu Province, China
| | - Jiajun Xing
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Street, Nanjing, 210029, Jiangsu Province, China
| | - Zixuan Gong
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Street, Nanjing, 210029, Jiangsu Province, China
| | - Aiming Xu
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Street, Nanjing, 210029, Jiangsu Province, China.
| | - Zengjun Wang
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Street, Nanjing, 210029, Jiangsu Province, China.
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Ramanathan S, Prasad M, Vora T, Badira CP, Kembhavi S, Ramadwar M, Khanna N, Laskar S, Muckaden MA, Qureshi S, Banavali S, Chinnaswamy G. Outcomes of relapsed/refractory extracranial germ cell tumors treated on conventional salvage chemotherapy without stem cell rescue: Experience from a tertiary cancer center. Pediatr Blood Cancer 2023; 70:e30179. [PMID: 36645132 DOI: 10.1002/pbc.30179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/14/2022] [Accepted: 12/06/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND AIMS Data on the outcome and prognostic indicators in extracranial relapsed/refractory germ cell tumors (rel/ref-GCTs) in children are limited to a few studies. This study looks at remission rates and outcomes of rel/ref-GCTs treated with conventional salvage chemotherapy (SC) regimens without stem cell rescue at a single center in the developing world. METHODS Patients treated at our center from January 2009 to December 2018 were included. Risk at primary presentation was stratified as all completely excised teratomas and stage I gonadal tumors being low risk (LR); stage IV ovarian, stage III-IV extragonadal GCTs as high risk (HR), and the remaining as intermediate risk (IR). SC regimens were: vinblastine-ifosfamide-cisplatin/carboplatin or paclitaxel-ifosfamide-cisplatin/carboplatin, or cisplatin/carboplatin-etoposide-bleomycin. Local therapy was either surgery and/or radiotherapy. RESULTS The analyzable cohort comprised 50 patients (44 = rel-GCTs; 6 = ref-GCTs) with a median age of 3.8 years and male:female ratio of 1.27:1. Primary location was ovary in 16 (32%), testicular in 10 (20%), and extragonadal in the rest (48%). Local, metastatic, and combined progression was noted in 28 (56%), 14 (28%), and eight (16%) patients, respectively, at a median time of 8.5 months. At a median follow-up of 60 months, the 5-year event-free survival (EFS) and overall survival (OS) of the entire cohort (n = 50) were 42.4% and 50.0%, respectively. In patients previously exposed to platinum analogs (n = 38), 5-year-EFS and OS were 27.7% and 31.7%, respectively. Local relapses did better when compared to metastatic and combined relapses (5-year EFS: 64% vs. 23% vs. 0%; p = .009). LR and IR tumors did better compared to HR (5-year EFS: 81.5% vs. 49.3% vs. 6.5%; p = .002). Patients with normalization of tumor markers after two cycles had a superior EFS (57.6% vs. 0%; p < .001). Relapsed tumors fared better than primary refractory GCTs (5-year EFS: 48.6% vs. 0%; p < .001). CONCLUSIONS Primary refractory GCTs, extragonadal rel-GCTs, and rel/ref-GCTs with a poor biochemical response did poorly with conventional SC and need alternative treatment strategies. The rel/ref-testicular GCTs had the best chance of salvage despite a second recurrence (5-year EFS and OS: 28.60% and 42.90%, respectively).
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Affiliation(s)
- Subramaniam Ramanathan
- Department of Paediatric Oncology, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle upon Tyne, Tyne and Wear, UK
| | - Maya Prasad
- Department of Paediatric Oncology, Tata Memorial hospital, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Tushar Vora
- Department of Paediatric Oncology, SickKids Hospital, Toronto, Ontario, Canada
| | - Cheriyalinkal Parambil Badira
- Department of Paediatric Oncology, Tata Memorial hospital, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Seema Kembhavi
- Department of Radiology, Mackay Hospital and Health Services, Mackay, Queensland, Australia
| | - Mukta Ramadwar
- Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nehal Khanna
- Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Siddhartha Laskar
- Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Mary Ann Muckaden
- Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sajid Qureshi
- Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Paediatric Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Shripad Banavali
- Department of Paediatric Oncology, Tata Memorial hospital, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Girish Chinnaswamy
- Department of Paediatric Oncology, Tata Memorial hospital, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Chovanec M, Adra N, Abu Zaid M, Abonour R, Einhorn L. High-dose chemotherapy for relapsed testicular germ cell tumours. Nat Rev Urol 2022; 20:217-225. [PMID: 36477219 DOI: 10.1038/s41585-022-00683-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 12/12/2022]
Abstract
Relapsed testicular germ cell tumours (GCTs) might be cured with salvage chemotherapy. Accepted salvage treatment is conventional-dose chemotherapy (CDCT) or high-dose chemotherapy (HDCT). HDCT with peripheral blood stem cell transplant might produce a higher number of durable responses than CDCT. We discuss studies reporting on outcomes of salvage HDCT in relapsed GCTs. The most reproducible results were achieved with HDCT with two cycles of etoposide and carboplatin or three cycles of the paclitaxel, ifosfamide, carboplatin and etoposide regime. Using these two regimens, sustained cure rates of 50-66% were reported in phase I, phase II and retrospective studies published in the past two decades. Cure rates in patients with cisplatin-resistant disease are between 30% and 45%. Two phase III randomized studies were conducted with certain limitations and were unsuccessful in showing a survival benefit of HDCT. Thus, salvage treatment remains a controversial topic. Salvage HDCT with peripheral blood stem cell transplant and CDCT are two recommended treatment options for relapsed GCTs. Consistently reported cure rates from phase I, phase II and large retrospective studies support the use of HDCT in the hands of an experienced team of oncologists.
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Abstract
Testicular cancer is a curable cancer. The success of physicians in curing the disease is underpinned by multidisciplinary advances. Cisplatin-based combination chemotherapy and the refinement of post-chemotherapy surgical procedures and diagnostic strategies have greatly improved long term survival in most patients. Despite such excellent outcomes, several controversial dilemmas exist in the approaches to clinical stage I disease, salvage chemotherapy, post-chemotherapy surgical procedures, and implementing innovative imaging studies. Relapse after salvage chemotherapy has a poor prognosis and the optimal treatment is not apparent. Recent research has provided insight into the molecular mechanisms underlying cisplatin resistance. Phase 2 studies with targeted agents have failed to show adequate efficacy; however, our understanding of cisplatin resistant disease is rapidly expanding. This review summarizes recent advances and discusses relevant issues in the biology and management of testicular cancer.
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Affiliation(s)
- Michal Chovanec
- 2nd Department of Oncology, Faculty of Medicine, Comenius University, National Cancer Institute, Bratislava, Slovakia
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown University, Lifespan Academic Medical Center, Providence, RI, USA
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Pierantoni F, Maruzzo M, Bimbatti D, Finotto S, Marino D, Galiano A, Basso U, Zagonel V. High dose chemotherapy followed by autologous hematopoietic stem cell transplantation for advanced germ cell tumors: State of the art and a single-center experience. Crit Rev Oncol Hematol 2021; 169:103568. [PMID: 34890801 DOI: 10.1016/j.critrevonc.2021.103568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Evidence for the choice of second line, standard vs high dose chemotherapy, (SDCT, HDCT) for patients with relapsed germ cell tumors (GCTs) comes mainly from retrospective studies. MATERIAL AND METHODS relevant literature was reviewed, considering as endpoints both survival and long term quality of life (QoL). Patients with metastatic GCT progressing after first-line treatment at our Institution were retrospectively evaluated. RESULTS HDCT seems to achieve a higher rate of long-term remissions. QoL data for this group of patients are lacking. Our experience on 29 patients was in line with these results. Two-year OS for the 18 patients treated with one or two HDCT/PBSCT procedures was 47.5 %, while 2-year PFS was 44 %. For the 11 receiving SDCT 2-year OS was 36.4 %, and 2-year PFS was 32.7 %. CONCLUSIONS HDCT/PBSCT confirmed to be effective in treating patients with relapsed GCT, but prospective studies are needed.
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Affiliation(s)
| | - Marco Maruzzo
- Oncologia 1, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Davide Bimbatti
- Oncologia 1, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Silvia Finotto
- Oncologia 1, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Dario Marino
- Oncologia 1, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | | | - Umberto Basso
- Oncologia 1, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
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8
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Carbonnaux M, Vinceneux A, Peyrat P, Fléchon A. [Treatment of testicular germ cell tumors relapse]. Bull Cancer 2020; 107:912-924. [PMID: 32653158 DOI: 10.1016/j.bulcan.2020.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/05/2020] [Accepted: 03/25/2020] [Indexed: 11/17/2022]
Abstract
Seminomatous (SGCT) and non-seminomatous (NSGCT) germ cell tumors (GCT) are rare but their incidence are increasing. We will discuss different therapeutic strategies in relapse disease: patients with stage I germ cell tumor have an excellent prognosis with a cure rate approaching 98-99 %, whatever the histology and the chosen treatment (surveillance strategy or adjuvant treatment). Relapses are observed among 20% of patients with stage I SGCT or low risk NSGCT and 50 % of patients with high risk NSGCT. Patients are treated according to the international prognosis group (IGCCCG) for SGCT and low risk NSGCT, naïve of chemotherapy. After an adjuvant treatment, the protocol must be adapted to the number of previous cycles (1 or 2 BEP) and to the prognosis group. Five to 50% of patients relapse after a first line of metastatic chemotherapy according to initial prognosis group. Dose-dense chemotherapy according to the GETUG13 protocol reduces the risk of relapse for the patients with poor-risk group NSGCT and unfavorable tumor marker decline. The prognosis of patients with relapsed or refractory GCT after a first line is more negative since only half of them will be cured by salvage standard chemotherapy. An international therapeutic trial (TIGER) is ongoing in first line salvage treatment evaluating high-dose chemotherapy (HDCT) with hematopoietic stem cell transplantation (HSCT). Finally, developing biomarkers for predicting clinical relapse, the management in expert centers of these patients and participation in therapeutic innovation are important perspectives for a better understanding and treatment of these patients with a poorer prognosis.
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Affiliation(s)
- Mélodie Carbonnaux
- Département d'oncologie médicale, centre Léon-Bérard, 28, rue Laennec, 69337 Lyon cedex 08, France.
| | - Armelle Vinceneux
- Département d'oncologie médicale, centre Léon-Bérard, 28, rue Laennec, 69337 Lyon cedex 08, France
| | - Patrice Peyrat
- Département de chirurgie, centre Léon-Bérard, 28, rue Laennec, 69337 Lyon cedex 08, France
| | - Aude Fléchon
- Département d'oncologie médicale, centre Léon-Bérard, 28, rue Laennec, 69337 Lyon cedex 08, France
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Shamash J, Mee M, Sarker SJ, Wilson P, Ansell W, Greenwood M, Berney D, Alifrangis C. Dose-dense chemotherapy for untreated poor-prognosis and relapsed germ-cell tumours: an 18-year experience with GAMEC chemotherapy. BJU Int 2020; 125:843-852. [DOI: 10.1111/bju.14947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Jonathan Shamash
- Department of Medical Oncology; St Bartholomew's Hospital; London UK
| | - Matthew Mee
- Department of Medical Oncology; St Bartholomew's Hospital; London UK
| | - Shah-Jalal Sarker
- Department of Medical Oncology; St Bartholomew's Hospital; London UK
| | - Peter Wilson
- Department of Medical Oncology; St Bartholomew's Hospital; London UK
| | - Wendy Ansell
- Department of Medical Oncology; St Bartholomew's Hospital; London UK
| | | | - Dan Berney
- Department of Histopathology; St Bartholomew's Hospital; London UK
| | - Constantine Alifrangis
- Department of Medical Oncology; St Bartholomew's Hospital; London UK
- Department of Medical Oncology; University College London Hospital; London UK
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Park JR, Kreissman SG, London WB, Naranjo A, Cohn SL, Hogarty MD, Tenney SC, Haas-Kogan D, Shaw PJ, Kraveka JM, Roberts SS, Geiger JD, Doski JJ, Voss SD, Maris JM, Grupp SA, Diller L. Effect of Tandem Autologous Stem Cell Transplant vs Single Transplant on Event-Free Survival in Patients With High-Risk Neuroblastoma: A Randomized Clinical Trial. JAMA 2019; 322:746-755. [PMID: 31454045 PMCID: PMC6714031 DOI: 10.1001/jama.2019.11642] [Citation(s) in RCA: 185] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Induction chemotherapy followed by high-dose therapy with autologous stem cell transplant and subsequent antidisialoganglioside antibody immunotherapy is standard of care for patients with high-risk neuroblastoma, but survival rate among these patients remains low. OBJECTIVE To determine if tandem autologous transplant improves event-free survival (EFS) compared with single transplant. DESIGN, SETTING, AND PARTICIPANTS Patients were enrolled in this randomized clinical trial from November 2007 to February 2012 at 142 Children's Oncology Group centers in the United States, Canada, Switzerland, Australia, and New Zealand. A total of 652 eligible patients aged 30 years or younger with protocol-defined high-risk neuroblastoma were enrolled and 355 were randomized. The final date of follow-up was June 29, 2017, and the data analyses cut-off date was June 30, 2017. INTERVENTIONS Patients were randomized to receive tandem transplant with thiotepa/cyclophosphamide followed by dose-reduced carboplatin/etoposide/melphalan (n = 176) or single transplant with carboplatin/etoposide/melphalan (n = 179). MAIN OUTCOMES AND MEASURES The primary outcome was EFS from randomization to the occurrence of the first event (relapse, progression, secondary malignancy, or death from any cause). The study was designed to test the 1-sided hypothesis of superiority of tandem transplant compared with single transplant. RESULTS Among the 652 eligible patients enrolled, 297 did not undergo randomization because they were nonrandomly assigned (n = 27), ineligible for randomization (n = 62), had no therapy (n = 1), or because of physician/parent preference (n = 207). Among 355 patients randomized (median diagnosis age, 36.1 months; 152 [42.8%] female), 297 patients (83.7%) completed the study and 21 (5.9%) were lost to follow-up after completing protocol therapy. Three-year EFS from the time of randomization was 61.6% (95% CI, 54.3%-68.9%) in the tandem transplant group and 48.4% (95% CI, 41.0%-55.7%) in the single transplant group (1-sided log-rank P=.006). The median (range) duration of follow-up after randomization for 181 patients without an event was 5.6 (0.6-8.9) years. The most common significant toxicities following tandem vs single transplant were mucosal (11.7% vs 15.4%) and infectious (17.9% vs 18.3%). CONCLUSIONS AND RELEVANCE Among patients aged 30 years or younger with high-risk neuroblastoma, tandem transplant resulted in a significantly better EFS than single transplant. However, because of the low randomization rate, the findings may not be representative of all patients with high-risk neuroblastoma. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00567567.
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Affiliation(s)
- Julie R. Park
- Department of Pediatrics, Seattle Children’s Hospital, Seattle, Washington
- University of Washington, Seattle
| | - Susan G. Kreissman
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Wendy B. London
- Department of Pediatrics, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts
| | - Arlene Naranjo
- Department of Biostatistics, University of Florida, Children’s Oncology Group Statistics and Data Center, Gainesville
| | | | - Michael D. Hogarty
- Department of Pediatrics Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Sheena C. Tenney
- Department of Biostatistics, University of Florida, Children’s Oncology Group Statistics and Data Center, Gainesville
| | - Daphne Haas-Kogan
- Department of Radiation Oncology, Dana Farber/Brigham and Women’s Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Peter John Shaw
- Bone Marrow Transplant, Children's Hospital at Westmead, Sydney, Australia
| | | | - Stephen S. Roberts
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, Manhattan, New York
| | - James Duncan Geiger
- Section of Pediatric Surgery, CS Mott Children’s Hospital, Michigan Medicine, Ann Arbor
| | - John J. Doski
- Departments of Surgery and Pediatrics, UT Health San Antonio, San Antonio, Texas
| | - Stephan D. Voss
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - John M. Maris
- Department of Pediatrics Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Stephan A. Grupp
- Department of Pediatrics Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Lisa Diller
- Department of Pediatrics, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts
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11
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Lavoie JM, Kollmannsberger CK. Current Management of Disseminated Germ Cell Tumors. Urol Clin North Am 2019; 46:377-388. [DOI: 10.1016/j.ucl.2019.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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12
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Autologous Stem-Cell Transplantation Outcomes for Relapsed Metastatic Germ-Cell Tumors in the Modern Era. Clin Genitourin Cancer 2019; 17:58-64.e1. [DOI: 10.1016/j.clgc.2018.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/06/2018] [Accepted: 09/12/2018] [Indexed: 11/18/2022]
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Leon-Rodriguez E, Rivera-Franco MM, Lacayo-Leñero D, Campos-Castro A, Meneses-Medina MI. First - line, non - cryopreserved autologous stem cell transplant for poor - risk germ - cell tumors: Experience in a developing country. Int Braz J Urol 2018; 45:74-82. [PMID: 30325602 PMCID: PMC6442144 DOI: 10.1590/s1677-5538.ibju.2017.0562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 07/22/2018] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The current first - line treatment for non - seminomatous germ cell tumor (NSGCT) consists of four cycles of cisplatin, etoposide, and bleomycin (BEP), which results in 5 - year overall survival < 60% in patients with poor - risk features. Autologous hematopoietic stem cell transplantation (auto - HSCT) as a method for overcoming high toxicity after high dose chemotherapy (HDC) has been explored in different solid tumors, but has remained standard practice only for NSGCT. Our objective was to describe outcomes of patients with poor - risk NSGCT who underwent first - line autologous HSCT in a tertiary center in Mexico. PATIENTS AND METHODS Twenty nine consecutive patients with NSGCT who received first - line, non - cryopreserved autologous HSCT at the National Institute of Medical Sciences and Nutrition Salvador Zubiran in Mexico City, Mexico, from November 1998 to June 2016, were retrospectively analyzed. RESULTS The median age at transplantation was 23 (15 - 39) years. Most patients (n = 18, 62%) had testicular primary tumor, and 23 had metastases (79%). Complete response after auto - HSCT was observed in 45%. Non - relapse mortality was 0. Five - year relapse / progression free and overall survival were 67% and 69%, respectively. CONCLUSIONS This small single limited - resource institution study demonstrated that patients with poor - risk NSGCT are curable by first - line HDC plus autologous HSCT and that this procedure is feasible and affordable to perform using non - cryopreserved hematopoietic stem cells.
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Affiliation(s)
- Eucario Leon-Rodriguez
- Stem Cell Transplantation Program, Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Monica M Rivera-Franco
- Stem Cell Transplantation Program, Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Dennis Lacayo-Leñero
- Stem Cell Transplantation Program,Hematology Section, Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Andrea Campos-Castro
- Stem Cell Transplantation Program,Hematology Section, Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Monica I Meneses-Medina
- Stem Cell Transplantation Program, Oncology Section, Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran Mexico City, Mexico
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Riedinger CB, Labbate C, Werntz RP, Eggener SE. Late Relapse of Nonseminomatous Germ Cell Tumor 24 Years Later. Urology 2018; 122:16-18. [PMID: 30170087 DOI: 10.1016/j.urology.2018.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 08/07/2018] [Accepted: 08/14/2018] [Indexed: 10/28/2022]
Affiliation(s)
| | - Craig Labbate
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL
| | - Ryan P Werntz
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL
| | - Scott E Eggener
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL
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Abstract
Over the past 5 decades, the use of well-validated, guideline-based strategies has resulted in high cure rates in newly diagnosed patients with germ cell cancer. However, about 30% of those with metastatic disease at initial presentation will experience refractory disease. Salvage treatment is far more complex and less validated than first-line treatment because it is rare, patient cohorts are more heterogeneous, and prognostic factors seem to have greater impact. Prior to the initiation of any salvage treatment, several considerations must be made, including assessment of known prognostic factors and choice of the optimal salvage strategy. Evaluation of patients according to their disease biology, response to prior treatment, and the extent of their tumor burden at the time of salvage treatment is crucial for establishing the optimal salvage strategy. Patients with metastatic germ cell cancer in whom adequate cisplatin-based first-line chemotherapy fails should be included in the ongoing randomized TIGER trial comparing conventional-dose chemotherapy with high-dose chemotherapy as first salvage treatment. Outside this trial, patients may be treated with conventional or high-dose chemotherapy depending on the presence or absence of adverse prognostic factors, availability of resources, and patient and physician preferences.
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Affiliation(s)
- Anja Lorch
- From Genitourinary Medical Oncology, Department of Urology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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16
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Oing C, Lorch A. The Role of Salvage High-Dose Chemotherapy in Relapsed Male Germ Cell Tumors. Oncol Res Treat 2018; 41:365-369. [PMID: 29843143 DOI: 10.1159/000489135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 04/11/2018] [Indexed: 11/19/2022]
Abstract
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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Zschäbitz S, Distler FA, Krieger B, Wuchter P, Schäfer-Eckart K, Jenzer M, Hohenfellner M, Dreger P, Haag GM, Jäger D, Pahernik S, Grüllich C. Survival outcomes of patients with germ cell tumors treated with high-dose chemotherapy for refractory or relapsing disease. Oncotarget 2018; 9:22537-22545. [PMID: 29854297 PMCID: PMC5976483 DOI: 10.18632/oncotarget.25162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/04/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction 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. Results 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. Materials and Methods 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. Conclusions 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.
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Affiliation(s)
- Stefanie Zschäbitz
- Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Florian A Distler
- Department of Urology, Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Benjamin Krieger
- Department of Oncology and Hematology, Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Patrick Wuchter
- Department of Hematology, Oncology, and Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, Germany.,Present address: Institute for Transfusion Medicine and Immunology Mannheim, Medical Faculty Mannheim, University of Heidelberg, DRK-Blutspendedienst Baden-Württemberg-Hessen gGmbH, 68167 Mannheim, Germany
| | - Kerstin Schäfer-Eckart
- Department of Oncology and Hematology, Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Maximilian Jenzer
- Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Markus Hohenfellner
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Peter Dreger
- Department of Hematology, Oncology, and Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Georg Martin Haag
- Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Dirk Jäger
- Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Sascha Pahernik
- Department of Urology, Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Carsten Grüllich
- Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, 69120 Heidelberg, Germany
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Role of one, two and three doses of high-dose chemotherapy with autologous transplantation in the treatment of high-risk or relapsed testicular cancer: a systematic review. Bone Marrow Transplant 2018; 53:1242-1254. [PMID: 29703969 DOI: 10.1038/s41409-018-0188-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/22/2018] [Accepted: 03/27/2018] [Indexed: 11/09/2022]
Abstract
Approximately 20-30% of patients with metastatic germ cell cancers (GCCs) can develop relapsed or refractory (RR) disease, about 40-50% of patients who relapse after salvage chemotherapy may reach long-term remission. The goal of this review was to identify patients who appear to benefit from high-dose chemotherapy (HDCT) and autologous stem cell transplant (ASCT). To access this, we performed a systematic medical literature review to evaluate the effectiveness of HDCT in the frontline setting, as well as in patients with RR testicular cancer. We searched databases for interventional clinical studies and identified 5883 studies. We selected 49 studies for inclusion, which included a total of 5985 patients. Seventeen studies reported results of newly diagnosed poor-risk GCC patients and 32 studies reported results of RR patients. For newly diagnosed patients with poor prognostic predictors, a risk adjusted strategy using unfavorable tumor marker decline with initial standard chemotherapy regimen and upfront HDCT demonstrated improved outcomes. Our data suggest a minimum of two HDCT cycles with ASCT should be standard of care for patients with RR GCC. Failure of HDCT results in a poor prognosis with only 10% of patients achieving lasting remission with salvage therapy.
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Nilius V, Killer MC, Timmesfeld N, Schmitt M, Moll R, Lorch A, Beyer J, Mack E, Lohoff M, Burchert A, Neubauer A, Brendel C. High β-1,4-Galactosyltransferase-I expression in peripheral T-lymphocytes is associated with a low risk of relapse in germ-cell cancer patients receiving high-dose chemotherapy with autologous stem cell reinfusion. Oncoimmunology 2018; 7:e1423169. [PMID: 29721375 PMCID: PMC5927517 DOI: 10.1080/2162402x.2017.1423169] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/20/2017] [Accepted: 12/22/2017] [Indexed: 11/21/2022] Open
Abstract
Survival of patients with germ-cell cancer (GCC) and primary progression or relapse after cisplatin-based first-line chemotherapy is highly heterogeneous, ranging from close to zero to more than 70%. We investigated β-1,4-Galactosyltransferase-I (B4GALT1) expression levels in peripheral lymphocytes in a cohort of 46 testicular cancer patients. B4GALT1 enhances immune cell crosstalk via glycosylation of surface molecules. A high expression level of B4GALT1 in T-lymphocytes, but not in monocytes, was associated with a lower risk of relapse with a hazard ratio (HR) of 0.66 (95% confidence interval (CI) of HR: 0.45-0.97; p = 0.02) upon multivariate Cox regression analysis. Correspondingly, interleukin 10 (IL10), a cytokine released by cytotoxic T-cells, was likewise significantly elevated in T-lymphocytes of non-relapse GCC patients (HR: 0.3; 95% CI of HR: 0.14-0.65; p = 0.002). Our data indicate that glycosylation and activation of T-lymphocytes may play a pivotal role in disease control in GCC patients with primary progressive or relapsed disease.
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Affiliation(s)
- Verena Nilius
- Department of Hematology, Oncology and Immunology at the Philipps-University Marburg; Baldinger Strasse, Marburg, Germany
| | - Madeleine C Killer
- Department of Hematology, Oncology and Immunology at the Philipps-University Marburg; Baldinger Strasse, Marburg, Germany
| | - Nina Timmesfeld
- Institute of Medical Biometry and Epidemiology at the Philipps-University Marburg, Bunsenstrasse 3, Marburg, Germany
| | - Melina Schmitt
- Department of Hematology, Oncology and Immunology at the Philipps-University Marburg; Baldinger Strasse, Marburg, Germany
| | - Roland Moll
- Institute of Pathology at the Philipps-University Marburg; Baldinger Strasse, Marburg
| | - Anja Lorch
- Department of Urology at the Heinrich-Heine-University Düsseldorf; Moorenstrasse 5, Düsseldorf, Germany
| | - Jörg Beyer
- Department of Oncology, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Elisabeth Mack
- Department of Hematology, Oncology and Immunology at the Philipps-University Marburg; Baldinger Strasse, Marburg, Germany
| | - Michael Lohoff
- Institute of Microbiology at the Philipps-University Marburg, Hans-Meerwein Strasse, Marburg, Germany
| | - Andreas Burchert
- Department of Hematology, Oncology and Immunology at the Philipps-University Marburg; Baldinger Strasse, Marburg, Germany
| | - Andreas Neubauer
- Department of Hematology, Oncology and Immunology at the Philipps-University Marburg; Baldinger Strasse, Marburg, Germany
| | - Cornelia Brendel
- Department of Hematology, Oncology and Immunology at the Philipps-University Marburg; Baldinger Strasse, Marburg, Germany
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20
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Abstract
Germ cell tumors are rare neoplasms that affect young males. Nearly 99% of patients with localized stage I disease and nearly 80% of patients with metastatic disease can be cured. Even patients who relapse following chemotherapy can achieve a long-term survival in approximately 30–40% of cases. The main objective in early stages and in good prognosis patients has changed in recent years, and it has become of major importance to reduce treatment-related morbidity without compromising the excellent long-term survival rate. In poor prognosis patients, there is a correlation between the experience of the treating institution and the long-term clinical outcome of the patients, particularly when the most sophisticated therapies are needed. So far, of utmost importance is the information from updated practice guidelines for the diagnosis and treatment of germ cell tumors. The Italian Germ cell cancer Group (IGG) has developed the following clinical recommendations, which identify the current standards in diagnosis and treatment of germ cell tumors in adult males.
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21
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Gössi F, Spahn M, Samaras P, Beyer J, Schardt J, Pabst T. Response to first-line treatment and histology are associated with achieving complete remission after the first salvage high-dose chemotherapy in relapsing germ cell tumor patients. Bone Marrow Transplant 2018; 53:820-825. [DOI: 10.1038/s41409-018-0089-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/07/2017] [Accepted: 12/20/2017] [Indexed: 11/09/2022]
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Steinemann G, Dittmer A, Kuzyniak W, Hoffmann B, Schrader M, Schobert R, Biersack B, Nitzsche B, Höpfner M. Animacroxam, a Novel Dual-Mode Compound Targeting Histone Deacetylases and Cytoskeletal Integrity of Testicular Germ Cell Cancer Cells. Mol Cancer Ther 2017; 16:2364-2374. [PMID: 28838999 DOI: 10.1158/1535-7163.mct-17-0293] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/26/2017] [Accepted: 08/09/2017] [Indexed: 11/16/2022]
Abstract
Novel approaches for the medical treatment of advanced solid tumors, including testicular germ cell tumors (TGCT), are desperately needed. Especially, TGCT patients not responding to cisplatin-based therapy need therapeutic alternatives, as there is no effective medical treatment available for this particular subgroup. Here, we studied the suitability of the novel dual-mode compound animacroxam for TGCT treatment. Animacroxam consists of an HDAC-inhibitory hydroxamate moiety coupled to a 4,5-diarylimidazole with inherent cytoskeleton disrupting potency. Animacroxam revealed pronounced antiproliferative, cell-cycle arresting, and apoptosis-inducing effects in TGCT cell lines with different cisplatin sensitivities. The IC50 values of animacroxam ranged from 0.22 to 0.42 μmol/L and were not correlated to the cisplatin sensitivity of the tumor cells. No unspecific cytotoxicity of animacroxam was observed in either cisplatin-sensitive or resistant TGCT cells, even at doses as high as 10 μmol/L. Furthermore, animacroxam induced the formation of actin stress fibers in cancer cells, thereby confirming the cytoskeleton-disrupting and antimigratory properties of its imidazole moiety. When compared with the clinically established HDAC inhibitor vorinostat, the novel dual-mode compound animacroxam exhibited superior antitumoral efficacy in vitro Animacroxam also reduced the tumor size of TGCT tumors in vivo, as evidenced by performing xenograft experiments on tumor bearing chorioallantoic membranes of fertilizes chicken eggs (CAM assay). The in vivo experiments also revealed a very good tolerability of the compound, and hence, animacroxam may be a promising candidate for innovative treatment of TGCT in general and the more so for platinum-insensitive or refractory TGCT. Mol Cancer Ther; 16(11); 2364-74. ©2017 AACR.
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Affiliation(s)
- Gustav Steinemann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology
| | - Alexandra Dittmer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology
| | - Weronika Kuzyniak
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology
| | - Björn Hoffmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology
| | - Mark Schrader
- Clinic of Urology, Helios Clinic Berlin-Buch, Berlin, Germany
| | - Rainer Schobert
- Organic Chemistry Laboratory, University of Bayreuth, Bayreuth, Germany
| | - Bernhard Biersack
- Organic Chemistry Laboratory, University of Bayreuth, Bayreuth, Germany
| | - Bianca Nitzsche
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology
| | - Michael Höpfner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology.
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Consensus Recommendations from the Spanish Germ Cell Cancer Group on the Use of High-dose Chemotherapy in Germ Cell Cancer. Eur Urol Focus 2017; 3:280-286. [PMID: 28753776 DOI: 10.1016/j.euf.2016.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/29/2016] [Accepted: 07/06/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND High-dose chemotherapy (HDCT) has been studied in several clinical scenarios in advanced germ cell cancer (GCC). OBJECTIVE To establish a clinical practice guideline for HDCT use in the treatment of GCC patients. DESIGN, SETTING, AND PARTICIPANTS An expert panel reviewed information available from the literature. The panel addressed relevant issues concerning and related to HDCT. The guideline was externally reviewed by two international experts. RESULTS AND LIMITATIONS The efficacy of HDCT has been demonstrated in selected GCC patients. The most conclusive evidence comes from retrospective analyses that need to be interpreted with caution. HDCT can cure a significant proportion of heavily treated GCC patients. When indicated, sequential HDCT with regimens containing carboplatin and etoposide, as well as peripheral stem-cell support, is recommended. There is no conclusive evidence to recommend HDCT as first-line therapy. According to a multinational retrospective pooled analysis, HDCT might be superior to conventional CT as first salvage treatment in selected patients. There is an urgent need for prospective clinical trials addressing the value of HDCT in GCC patients who experience failure on first-line cisplatin-based CT. In patients who progress on conventional-dose salvage CT, HDCT should be considered. Treatment of these patients at experienced centers is strongly recommended. CONCLUSIONS It has been demonstrated that HDCT cures selected GCC patients who experience disease progression on conventional rescue regimens. The panel recommends the inclusion of GCC patients in randomized clinical trials including HDCT. PATIENT SUMMARY This consensus establishes clinical practice guidelines for the use and study of high-dose chemotherapy in patients with germ cell cancer.
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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 Transplant 2016; 52:334-336. [PMID: 27892951 DOI: 10.1038/bmt.2016.285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lorch A, Beyer J. High-dose chemotherapy as salvage treatment in germ-cell cancer: when, in whom and how. World J Urol 2016; 35:1177-1184. [DOI: 10.1007/s00345-016-1941-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 09/19/2016] [Indexed: 03/08/2023] Open
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DeFilipp Z, Rosand CB, Goldstein DA, Master VA, Carthon BC, Harris WB, Kucuk O, Al-Kadhimi Z, Cohen JB, Flowers CR, Lechowicz MJ, Nooka AK, Kaufman JL, Langston AA, Chen Z, Arora J, Waller EK. Comparable outcomes following two or three cycles of high-dose chemotherapy and autologous stem cell transplantation for patients with relapsed/refractory germ cell tumors. Bone Marrow Transplant 2016; 52:132-134. [PMID: 27427922 DOI: 10.1038/bmt.2016.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Z DeFilipp
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - C B Rosand
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - D A Goldstein
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - V A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - B C Carthon
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - W B Harris
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - O Kucuk
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Z Al-Kadhimi
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - J B Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - C R Flowers
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - M J Lechowicz
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - A K Nooka
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - J L Kaufman
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - A A Langston
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Z Chen
- Department of Biostatistics and Bioinformatics, Emory University School of Public Health, Atlanta, GA, USA
| | - J Arora
- Department of Biostatistics and Bioinformatics, Emory University School of Public Health, Atlanta, GA, USA
| | - E K Waller
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
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Lewin J, Dickinson M, Voskoboynik M, Collins M, Ritchie D, Toner G. High-dose chemotherapy with autologous stem cell transplantation in relapsed or refractory germ cell tumours: outcomes and prognostic variables in a case series of 17 patients. Intern Med J 2015; 44:771-8. [PMID: 24893627 DOI: 10.1111/imj.12486] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 05/25/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Optimal therapy for men relapsing after initial chemotherapy for germ cell tumours (GCT) is poorly defined. Both conventional dose salvage regimens and high-dose chemotherapy with autologous stem cell transplantation (HDCT-ASCT) have been utilised. AIMS To examine patients who received HDCT-ASCT for relapsed GCT within a single Australian centre. METHODS Records between 2000 and 2012 were analysed for baseline characteristics, treatment-related toxicity and survival. Prognosis at the time of HDCT-ASCT was classified according to the International Prognostic Factors Study Group (IPFSG). RESULTS Seventeen patients received HDCT-ASCT, median age 34 (21-46), with 41% having primary refractory disease and 53% with high/very high risk disease by IPFSG. The most common regimen utilised was paclitaxel/ifosfamide followed by high-dose carboplatin/etoposide (TI-CE; n = 12). The median duration of grade 4 (G4) neutropenia was 11 days (range 9-17) with febrile neutropenia in 90% resulting in four intensive care unit admissions (8%). Median duration of G4 thrombocytopenia was 10 days (range 8-19) requiring a median of two pooled platelets bags (range 0-33) per episode. Transplant-related mortality occurred in one patient (veno-occlusive disease). Twenty-seven per cent of HDCT-ASCT cycles were associated with grade 3 mucositis (median total parenteral nutrition days = 5 (0-23)). Two-year progression-free survival (PFS) and overall survival (OS) rates were 59% and 71%. Patients who received HDCT-ASCT as second or subsequent relapse fared worse than those treated with HDCT-ASCT at first relapse (hazard ratio 0.23 (95% confidence interval: 0.04, 1.37; P-value 0.09). Three-year OS for those who received TI-CE at first relapse was 90%. CONCLUSIONS HDCT-ASCT for relapsed GCT is effective with acceptable toxicity. There was encouraging PFS/OS, particularly in a poor-prognosis cohort.
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Affiliation(s)
- J Lewin
- DHMO, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Ontrac, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Albers P, Albrecht W, Algaba F, Bokemeyer C, Cohn-Cedermark G, Fizazi K, Horwich A, Laguna MP, Nicolai N, Oldenburg J. Guidelines on Testicular Cancer: 2015 Update. Eur Urol 2015; 68:1054-68. [PMID: 26297604 DOI: 10.1016/j.eururo.2015.07.044] [Citation(s) in RCA: 443] [Impact Index Per Article: 49.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 07/18/2015] [Indexed: 11/16/2022]
Abstract
CONTEXT This is an update of the previous European Association of Urology testis cancer guidelines published in 2011, which included major changes in the diagnosis and treatment of germ cell tumours. OBJECTIVE To summarise latest developments in the treatment of this rare disease. Recommendations have been agreed within a multidisciplinary working group consisting of urologists, medical oncologists, and radiation oncologists. EVIDENCE ACQUISITION A semi-structured literature search up to February 2015 was performed to update the recommendations. In addition, this document was subjected to double-blind peer review before publication. EVIDENCE SYNTHESIS This publication focuses on the most important changes in treatment recommendations for clinical stage I disease and the updated recommendations for follow-up. CONCLUSIONS Most changes in the recommendations will lead to an overall reduction in treatment burden for patients with germ cell tumours. In advanced stages, treatment intensification is clearly defined to further improve overall survival rates. PATIENT SUMMARY This is an update of a previously published version of the European Association of Urology guidelines for testis cancer, and includes new recommendations for clinical stage I disease and revision of the follow-up recommendations. Patients should be fully informed of all the treatment options available to them.
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Affiliation(s)
- Peter Albers
- Department of Urology, Medical Faculty, Düsseldorf University, Düsseldorf, Germany.
| | | | - Ferran Algaba
- Department of Pathology, Fundacio Puigvert, Barcelona, Spain
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with section Pneumology, Universitätskliniken Eppendorf, Hamburg, Germany
| | - Gabriella Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Karim Fizazi
- Department of Medicine, University of Paris XI, Villejuif, France
| | - Alan Horwich
- Academic Unit of Radiotherapy and Oncology, Royal Marsden NHS Trust and The Institute of Cancer Research, Sutton, UK
| | - Maria Pilar Laguna
- Department of Urology, Amsterdam Medical Centre, Amsterdam University, Amsterdam, The Netherlands
| | - Nicola Nicolai
- Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Jan Oldenburg
- Health Sciences, Høgskolen i Buskerud og Vestfold, Kongsberg, Norway
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Feldman DR, Glezerman I, Patil S, Van Alstine L, Bajorin DF, Fischer P, Hughes A, Sheinfeld J, Bains M, Reich L, Woo K, Giralt S, Bosl GJ, Motzer RJ. Phase I/II Trial of Paclitaxel With Ifosfamide Followed by High-Dose Paclitaxel, Ifosfamide, and Carboplatin (TI-TIC) With Autologous Stem Cell Reinfusion for Salvage Treatment of Germ Cell Tumors. Clin Genitourin Cancer 2015; 13:453-60. [PMID: 26072101 DOI: 10.1016/j.clgc.2015.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 05/03/2015] [Accepted: 05/08/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Salvage high-dose (HD) chemotherapy with autologous stem cell transplant (ASCT), consisting of 2 to 3 sequential cycles of HD carboplatin and etoposide (CE) can achieve durable remissions in approximately half of patients with relapsed germ cell tumors. To improve on these results and based on success with paclitaxel, ifosfamide, and cisplatin (TIP) as salvage conventional-dose chemotherapy, we conducted a phase I/II trial of HD paclitaxel with ifosfamide (TI), substituting carboplatin for cisplatin to allow dose escalation. PATIENTS AND METHODS Treatment consisted of 1 to 2 cycles of TI and granulocyte colony-stimulating factor for stem cell mobilization followed by 3 cycles of HD TI with carboplatin (TIC) with ASCT every 21 to 28 days. Twenty-six patients were enrolled. For phase I, a standard 3+3 dose-escalation design was used. RESULTS With no dose-limiting toxicities observed, the maximum tolerated dose (MTD) was not reached and the highest prespecified dose level (paclitaxel 250 mg/m(2), ifosfamide 9990 mg/m(2), carboplatin area under the curve 24) was considered the MTD. In phase II, a Simon 2-stage design was used to estimate the complete response (CR) rate at the MTD. With 7 of 11 phase II patients who achieved a CR, efficacy was demonstrated. However, 3 patients developed delayed chronic kidney disease, resulting in premature trial closure. CONCLUSION TI-TIC was active in relapsed germ cell tumors but treatment-emergent chronic renal impairment, possibly from overlapping ifosfamide and carboplatin, preclude its further use. TI-CE, consisting of 2 cycles of TI with 3 cycles of HD CE remains the standard of care HD chemotherapy regimen at Memorial Sloan Kettering Cancer Center.
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Affiliation(s)
- Darren R Feldman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, NY.
| | - Ilya Glezerman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Sujata Patil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lindsay Van Alstine
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dean F Bajorin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Patricia Fischer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Amanad Hughes
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joel Sheinfeld
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Manjit Bains
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lilian Reich
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Kaitlin Woo
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sergio Giralt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, NY
| | - George J Bosl
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Robert J Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, NY
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Salvage high-dose chemotherapy for germ cell tumors. Urol Oncol 2015; 33:355-62. [PMID: 25837842 DOI: 10.1016/j.urolonc.2015.01.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 01/11/2015] [Accepted: 01/28/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Salvage high-dose chemotherapy (HDCT) along with autologous stem cell transplant (ASCT) plays an important role in the management of patients with germ cell tumors (GCT) and progression after first-line cisplatin-based chemotherapy. In this review, the authors will discuss the history of HDCT as salvage management of patients with GCT, improvement in efficacy and safety over the past 25 years, prognostic factors for outcome, and the conflicting data on the optimal initial salvage approach. METHODS The authors performed a PubMed search of HDCT and GCT to identify articles relevant to this review. After discussion, the articles felt to have contributed most notably to the field were selected for inclusion and summarized. RESULTS Depending on patient selection and timing of HDCT, durable remission rates with salvage HDCT range between 30% and 63%. The combination of carboplatin and etoposide is the standard regimen for the high-dose cycles with more variability in the regimens used for stem cell mobilization. Adding a third agent, particularly an oxazophosphorine (cyclophosphamide and ifosfamide), may add toxicity without increasing efficacy. In addition, sequential (2 or 3 cycle) HDCT regimens appear more effective and safer than single-cycle HDCT regimens. The optimal initial salvage approach (HDCT or conventional-dose chemotherapy) remains an unanswered question and highly controversial. CONCLUSIONS Salvage HDCT with ASCT can cure a significant proportion of patients with GCT and progression after one or more lines of cisplatin-based chemotherapy and thus plays an important role in the contemporary management of high-risk patients.
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Nakamura T, Ueda T, Oishi M, Nakanishi H, Shiraishi T, Fujihara A, Naito Y, Kamoi K, Naya Y, Hongo F, Okihara K, Miki T. Importance of continuous sequential chemotherapy and multimodal treatment for advanced testicular cancer: a high-volume Japanese center experience. Medicine (Baltimore) 2015; 94:e653. [PMID: 25789960 PMCID: PMC4602480 DOI: 10.1097/md.0000000000000653] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Patients with "difficult-to-treat" advanced testicular cancer can require multiple therapies. We retrospectively assessed our patients with advanced germ cell tumors (GCTs) and characterized the clinical efficacy, outcomes, and factors affecting overall survival (OS).Two hundred fifty-three patients with advanced GCTs were treated at Kyoto Prefectural University of Medicine, Kyoto, Japan, from June 1998 to September 2013. Of 253 patients, 142 patients had salvage chemotherapy.As first-line therapy, bleomycin, etoposide, and cisplatin, and etoposide and cisplatin therapies were performed in 234 cases (92.5%). As second-line therapy, etoposide, ifosfamide, and cisplatin/vinblastine, ifosfamide, and cisplatin, and paclitaxel, ifosfamide, and cisplatin/paclitaxel, ifosfamide, and nedaplatin therapies were carried out in 44 and 59 cases, respectively. Furthermore, 111, 72, 44, and 28 cases had third, fourth, fifth, and sixth-or-later-line chemotherapy, respectively. Five-year OS rate stratified by chemotherapy line was 95.5% in the first line, 89.4% in the second line, 82.1% in the third line, 45.1% in the fourth line, and 58.9% in the fifth or after line. A statistical significant difference was found when comparing fourth-or-after-line versus first to third-line therapy. Additional procedures were performed, including retroperitoneal lymph node dissection (RPLND) (n = 168), extra-RPLN resection (n= 114), and external beam radiotherapy/stereotactic radiotherapy (n = 78).Multivariate analysis showed that factors predicting better outcomes were in serum tumor marker (STM) normalization, RPLND, and extra-RPLN resection.Good outcomes were obtained in patients who completed chemotherapy up to third line. After fourth-line chemotherapy, approximately 50% of "difficult-to-treat" patients could be cured with normalization of STM levels and residual mass resection. Continuous or sequential chemotherapy with multimodality therapy is important for patients with "difficult-to-treat" advanced GCTs. Effective chemotherapy after third line should be developed.
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Affiliation(s)
- Terukazu Nakamura
- From the Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Jacobsen C, Honecker F. Cisplatin resistance in germ cell tumours: models and mechanisms. Andrology 2014; 3:111-21. [PMID: 25546083 DOI: 10.1111/andr.299] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/22/2014] [Accepted: 09/24/2014] [Indexed: 12/11/2022]
Abstract
Recent years have led to a better understanding of the mechanisms underlying cisplatin response and resistance in germ cell tumours (GCT), and several promising targets have been identified. Two main mechanisms of the responsiveness to DNA damaging agents have been postulated. Firstly, GCT readily activate a DNA damage response, but show deficits in several damage repair pathways. In particular, they have been found to have defects in interstrand crosslink repair and in homologous recombination (HR). Secondly, GCT, especially embryonal carcinoma (EC) cells, show a hypersensitive apoptotic response to DNA damage, which activates p53, and leads to up-regulation of the pro-apoptotic factors Noxa, Puma and Fas in non-resistant EC. These cells fail to activate p21 which induces a G1/S arrest, but accumulate in G2/M phase. In the absence of functional p53, family members like p73 and GTAp63 might be important in initiating this response. Mechanisms involved in cisplatin resistance are as follows: down-regulation of Oct4 (e.g. as a result of hypoxia, treatment with retinoic acid or exposure to cisplatin) and failure to induce Puma and Noxa; changes in the expression levels of micro-RNAs such as miR-17/-106b, miR-302a, or miR-371 to -373; elevated levels of MDM2 and cytoplasmic translocation of p21 by phosphorylation; and activation of the PDGFRβ/PI3K/pAKT pathway. Several approaches to overcome resistance have been successfully examined in vitro and in vivo, including PARP inhibitors, especially in cells showing deficient HR-repair; stabilization of p53 using nutlin-3; inhibition of several components of the PI3K/pAKT pathway using small molecules; and DNA demethylation by 5-azacytidine or 5-aza-deoxy-cytidine, among others. Many of these substances deserve further exploration, alone or in combination with DNA damaging agents, and the most promising approaches should be taken forward to clinical testing. Targeted therapy based on mechanistic insights holds the promise to turn cisplatin-resistant GCT into a curable disease.
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Affiliation(s)
- C Jacobsen
- Department of Oncology, Haematology, Bone Marrow Transplantation with Section Pulmology, Hubertus Wald Tumor Center, Hamburg University Medical Center, University of Hamburg, Hamburg, Germany
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Necchi A, Lanza F, Rosti G, Martino M, Farè E, Pedrazzoli P. High-dose chemotherapy for germ cell tumors: do we have a model? Expert Opin Biol Ther 2014; 15:33-44. [PMID: 25243977 DOI: 10.1517/14712598.2015.963051] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Since the late nineties, the intensification of chemotherapy doses with hematopoietic stem cell rescue held promise for patients with advanced and poor prognosis germ cell tumors (GCTs). High-dose chemotherapy (HDCT) has, nowadays, a recognized indication in the salvage setting of advanced GCTs and is steadily utilized worldwide. AREAS COVERED We evaluated the available data with the use of HDCT in these patients. In addition, we provided an original perspective on several issues as experts on behalf of the European Society for Blood and Marrow Transplantation and IGG, including peripheral blood stem cells mobilization and the use of HDCT in special subpopulations of GCT, with the aim to help clarify critical issues in the absence of available clear-cut information. EXPERT OPINION Despite HDCT being currently considered a therapeutic option in the salvage setting, critical questions regarding patient selection are still unanswered. Eligibility of patients with a chemoresistant disease, the use of available prognostic factors as well as tumor marker decline in clinical practice are pending issues. Moving forward, these are critical arguments in favor of further clinical research in the field of advanced GCTs.
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Affiliation(s)
- Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Medical Oncology, Medical Oncology 2 Unit , Via G. Venezian 1, 20133 Milano , Italy +39 02 2390 2402 ; +39 02 2390 3150 ;
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Selle F, Wittnebel S, Biron P, Gravis G, Roubaud G, Bui BN, Delva R, Bay JO, Fléchon A, Geoffrois L, Caty A, Soares DG, de Revel T, Fizazi K, Gligorov J, Micléa JM, Dubot C, Provent S, Temby I, Gaulet M, Horn E, Brindel I, Lotz JP. A phase II trial of high-dose chemotherapy (HDCT) supported by hematopoietic stem-cell transplantation (HSCT) in germ-cell tumors (GCTs) patients failing cisplatin-based chemotherapy: the Multicentric TAXIF II study. Ann Oncol 2014; 25:1775-1782. [PMID: 24894084 DOI: 10.1093/annonc/mdu198] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND High-dose chemotherapy (HDCT) is an effective salvage treatment of germ-cell tumors (GCTs) patients. In the first salvage setting, 30%-70% of patients may achieve durable remissions. Even when HDCT is administered as subsequent salvage treatment, up to 20% of patients may still be definitively cured. However, patients with refractory/relapsed disease still have a very poor long-term prognosis, requiring earlier intervention of HDCT. PATIENTS AND METHODS This phase II trial was addressed to nonrefractory patients failing Cisplatin-based chemotherapy. Inclusion criteria included seminomatous GCT in relapse after two lines of chemotherapy, nonseminomatous GCT in relapse after first or second lines, partial remission after first line, primary mediastinal GCT in first relapse. Patients received two cycles combining Epirubicin and Paclitaxel (Epi-Tax), followed by three consecutive HDCT, one using a Paclitaxel/Thiotepa (Thio-Tax) association and two using the 5-day Ifosfamide-Carboplatin-Etoposide regimen. The main objective was to determine the complete response rate. RESULTS Forty-five patients were included between September 2004 and December 2007: 44 received the first HDCT cycle, 39 two HDCT cycles, 29 could receive the whole protocol. Sixteen patients did not receive the entire protocol, including eight (17.7%) for toxic side-effects. Two patients (4.4%) died of toxicities, and 17 (37.7%) of disease progression. With a median follow-up time of 26 months (range, 4-51), the final overall response rate was 48.8% (including a complete response rate of 15.5% and a partial response/negative serum markers rate of 26.6%) in an intent-to-treat analysis. The median progression-free survival (PFS) and overall survival (OS) times were 22 months [95% confidence interval (CI) 2-not reached] and 32 months (95% CI 4-49), respectively. The 2-year PFS was a plateau setup at 50% (95% CI 32-67) and the 2-year OS was 66% (95% CI 44-81). CONCLUSION The TAXIF II protocol was effective in nonrefractory GCT patients failing Cisplatin-based chemotherapy. The toxic death rate remained acceptable in the field of HDCT regimens. TRIAL REGISTRATION NUMBER NCT00231582.
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Affiliation(s)
- F Selle
- Department of Medical Oncology and Cellular Therapy, APREC (Alliance Pour la Recherche En Cancérologie), Hôpital Tenon (Hôpitaux Universitaires de l'Est-Parisien, AP-HP), Paris; Sorbonne Universités, Université Pierre et Marie Curie (UPMC Univ Paris 06), Paris.
| | - S Wittnebel
- Department of Medicine, Institut Gustave Roussy, Villejuif
| | - P Biron
- Department of Medical Oncology, Centre Léon Bérard, Lyon
| | - G Gravis
- Department of Medical Oncology, Institut Paoli Calmette, Marseille
| | - G Roubaud
- Department of Medicine, Institut Bergonié, Bordeaux
| | - B N Bui
- Department of Medicine, Institut Bergonié, Bordeaux
| | - R Delva
- Department of Chemotherapy, Centre Paul Papin, Angers
| | - J O Bay
- Department of Medicine, Centre Hospitalier Universitaire, Clermont-Ferrand
| | - A Fléchon
- Department of Medical Oncology, Centre Léon Bérard, Lyon
| | - L Geoffrois
- Department of Medicine, Centre Alexis Vautrin, Nancy
| | - A Caty
- Department of Medicine, Centre Oscar Lambret, Lille
| | - D G Soares
- Department of Medical Oncology and Cellular Therapy, APREC (Alliance Pour la Recherche En Cancérologie), Hôpital Tenon (Hôpitaux Universitaires de l'Est-Parisien, AP-HP), Paris
| | - T de Revel
- Department of Hematology, Hôpital D'Instruction des Armées Percy, Clamart
| | - K Fizazi
- Department of Medicine, Institut Gustave Roussy, Villejuif
| | - J Gligorov
- Department of Medical Oncology and Cellular Therapy, APREC (Alliance Pour la Recherche En Cancérologie), Hôpital Tenon (Hôpitaux Universitaires de l'Est-Parisien, AP-HP), Paris; Sorbonne Universités, Université Pierre et Marie Curie (UPMC Univ Paris 06), Paris
| | - J M Micléa
- Cytapheresis and Cell Therapy Unit, Hôpital St Louis (AP-HP), Paris
| | - C Dubot
- Department of Medical Oncology and Cellular Therapy, APREC (Alliance Pour la Recherche En Cancérologie), Hôpital Tenon (Hôpitaux Universitaires de l'Est-Parisien, AP-HP), Paris
| | - S Provent
- Department of Medical Oncology and Cellular Therapy, APREC (Alliance Pour la Recherche En Cancérologie), Hôpital Tenon (Hôpitaux Universitaires de l'Est-Parisien, AP-HP), Paris
| | - I Temby
- Department of Medical Oncology and Cellular Therapy, APREC (Alliance Pour la Recherche En Cancérologie), Hôpital Tenon (Hôpitaux Universitaires de l'Est-Parisien, AP-HP), Paris
| | - M Gaulet
- Statistic, 3ES-Cegedim Strategic Data, Boulogne, France
| | - E Horn
- Department of Internal Medicine, Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - I Brindel
- Department of Clinical Research, Hôpital St Louis (AP-HP), Paris, France
| | - J P Lotz
- Department of Medical Oncology and Cellular Therapy, APREC (Alliance Pour la Recherche En Cancérologie), Hôpital Tenon (Hôpitaux Universitaires de l'Est-Parisien, AP-HP), Paris; Sorbonne Universités, Université Pierre et Marie Curie (UPMC Univ Paris 06), Paris
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Beyer J. Miracles don't happen any more. Ann Oncol 2014; 25:1679-1680. [PMID: 25004919 DOI: 10.1093/annonc/mdu240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jörg Beyer
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland
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Nieto Y. Transplantation for refractory germ cell tumors: does it really make a difference? Curr Oncol Rep 2013; 15:232-8. [PMID: 23494829 DOI: 10.1007/s11912-013-0309-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
High-dose chemotherapy (HDC) has been used over the past 25 years for germ-cell tumors in a variety of clinical scenarios. There is consensus at this point that its use as part of first-line treatment does not benefit patients with high-risk tumors. Long-term results of prospective trials in patients with relapsed or with refractory disease indicate that a fraction of them achieve long-term remissions consistent with cures. While HDC constitutes for many oncologists in the US an accepted treatment modality for relapsed or refractory GCT, controversy surrounds its use in those settings. Prognostic models have been developed that allow to prospectively identify poor prognosis patients that might benefit from novel HDC-based approaches.
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Affiliation(s)
- Yago Nieto
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 423, Houston, TX, 77030, USA.
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Effects of cyclophosphamide and lactulose on the release of ammonia and medium-molecular-weight substances from the intestine into blood in rats. Bull Exp Biol Med 2013; 154:460-3. [PMID: 23486581 DOI: 10.1007/s10517-013-1977-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The effects of lactulose on the release of ammonia and medium-molecular-weight substances from the intestine into the blood and on the severity of cyclophosphamide intoxication were studied in rats. The pH and urease-dependent component of ammonia-producing activity of the cecal chyme decreased over 6 h after lactulose administration, while ammonia content in the chyme increased. Cyclophosphamide caused an increase in ammonia and, less so, glutamine level in the portal blood and in the blood collected after decapitation; this drug stimulated release of methylene blue and endogenous substances of medium-molecular-weight to the portal blood. Lactulose was virtually inessential for these changes and for the neurological status, mortality, and medium life span of rats. Hence, lactulose did not prevent cyclophosphamide-induced leakage of ammonia and medium-molecular-weight substances from the gastrointestinal tract into blood and did not reduce the severity of intoxication.
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Massard C, Kramar A, Beyer J, Hartmann JT, Lorch A, Pico JL, Rosti G, Droz JP, Fizazi K. Tumor marker kinetics predict outcome in patients with relapsed disseminated non-seminomatous germ-cell tumors. Ann Oncol 2013; 24:322-328. [PMID: 23104726 DOI: 10.1093/annonc/mds504] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND An early serum tumor marker (TM) decline during chemotherapy was shown to independently predict survival in patients with poor-prognosis disseminated non-seminomatous germ-cell tumors (NSGCTs). The aim of this study was to assess whether a TM decline (TMD) also correlates with the outcome in the salvage setting. PATIENTS AND METHODS Data regarding 400 patients with progressive or relapsed disseminated NSGCTs after first-line chemotherapy prospectively accrued onto two phase III clinical trials were obtained. Serum alpha-fetoprotein (AFP) and/or human chorionic gonadotropin (hCG) were assessed at baseline and after 6 weeks of chemotherapy. A total of 297 patients, 185 and 112 in the training and validation sets, with initially abnormal TMs for whom a change from baseline could be established were used for this analysis. RESULTS An unfavorable decline in either AFP or hCG was predictive of progression-free survival (PFS) [hazard ratio, HR = 2.15, (95% CI 1.48-3.11); P < 0.001; 2-year PFS rate: 50% versus 26%] as was the Lorch prognostic score (LPS). In the multivariate analysis, an unfavorable TMD, stratified based on the LPS, was an independent adverse prognostic factor for PFS and OS. CONCLUSION An unfavorable TMD during the first 6 weeks after chemotherapy is associated with a poorer outcome in patients with relapsed disseminated NSGCTs.
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Affiliation(s)
- C Massard
- Department of Medical Oncology, Institut Gustave Roussy, University of Paris Sud, Villejuif.
| | - A Kramar
- Unit of Biostatistics, Centre Oscar Lambret, Lille, France
| | - J Beyer
- Department of Cancer Medicine, Vivantes Klinikum am Urban, Berlin
| | - J T Hartmann
- Cancer Center North, Christian-Albrechts-Universität zu Kiel, Keil
| | - A Lorch
- Genitourinary Medical Oncology, Department of Urology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - J L Pico
- Department of Medical Oncology, Institut Gustave Roussy, University of Paris Sud, Villejuif
| | - G Rosti
- Department of Cancer Medicine, Ospedale Ca'Foncello, Treviso, Italy
| | - J P Droz
- Department of Cancer Medicine, Centre Léon-Bérard, Lyon, France
| | - K Fizazi
- Department of Medical Oncology, Institut Gustave Roussy, University of Paris Sud, Villejuif
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Beausoleil M, Ernst DS, Stitt L, Winquist E. Consolidative high-dose chemotherapy after conventional-dose chemotherapy as first salvage treatment for male patients with metastatic germ cell tumours. Can Urol Assoc J 2012; 6:111-6. [PMID: 22511417 DOI: 10.5489/cuaj.11233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Some men with metastatic germ cell tumours that have progressed after response to initial cisplatin-based combination chemotherapy are cured with conventional dose first salvage chemotherapy (CDCT)--however, many are not. High-dose chemotherapy with autologous stem cell rescue (HDCT) may be of value in these patients. Prognosis has recently been better defined by International Prognostic Factor Study Group (IPFSG) prognostic factors. HDCT after response to CDCT has been offered at our institution over the past two decades. We retrospectively assessed the validity of the IPFSG prognostic factors in our patients and evaluated the value of HDCT. METHODS We identified eligible men with metastatic germ cell tumour progressed after at least 3 cycles of cisplatin-based chemotherapy and treated with cisplatin-based CDCT alone or with carboplatin-based HDCT. We also collected their clinical data. Patients were classified into risk groups using IPFSG factors, and progression-free and overall survival factors were analyzed and compared in patients treated with CDCT alone and with HDCT. RESULTS We identified 38 eligible first salvage patients who had received a median of 4 cycles (range, 1 to 7 cycles) of CDCT. Twenty patients received CDCT alone and 18 patients received CDCT plus HDCT. The overall median progression- free survival was 24.6 months (95%CI, 7.3 to 28.7 months) and overall median overall survival was 34.6 months (95%CI, 17.2 to 51.3 months). Distribution by IPFSG category and 2-year progression- free survival and 3-year overall survival rates within each risk category were very similar to the IPFSG results. There were two toxic deaths with CDCT and none with HDCT. Overall, patients treated with CDCT plus HDCT had improved progression- free survival and overall survival. CONCLUSIONS The IPFSG prognostic risk factors appeared valid in our patient population. The safety of HDCT with etoposide and carboplatin was confirmed. HDCT was associated with improved progression- free survival and overall survival outcomes, consistent with observations of the IPFSG group. Ideally, the value of optimal HDCT should be determined in comparison to optimal CDCT as first salvage therapy in men with metastatic germ cell tumour with a randomized trial.
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Calabrò F, Albers P, Bokemeyer C, Martin C, Einhorn LH, Horwich A, Krege S, Schmoll HJ, Sternberg CN, Daugaard G. The Contemporary Role of Chemotherapy for Advanced Testis Cancer: A Systematic Review of the Literature. Eur Urol 2012; 61:1212-21. [DOI: 10.1016/j.eururo.2012.03.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 03/16/2012] [Indexed: 10/28/2022]
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Rashid S, Lim L, Powles T. Treatment of Relapsed/Refractory Germ Cell Tumours: An Equipoise Between Conventional and High Dose Therapy. Curr Treat Options Oncol 2012; 13:201-11. [DOI: 10.1007/s11864-012-0199-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lorch A, Kleinhans A, Kramar A, Kollmannsberger CK, Hartmann JT, Bokemeyer C, Rick O, Beyer J. Sequential Versus Single High-Dose Chemotherapy in Patients With Relapsed or Refractory Germ Cell Tumors: Long-Term Results of a Prospective Randomized Trial. J Clin Oncol 2012; 30:800-5. [PMID: 22291076 DOI: 10.1200/jco.2011.38.6391] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate the long-term survival rates in patients with relapsed or refractory germ cell tumors (GCTs) after single or sequential high-dose chemotherapy (HDCT). Patients and Methods Between November 1999 and November 2004, 211 patients with relapsed or refractory GCT were randomly assigned to treatment with either one cycle of cisplatin 100 mg/m2, etoposide 375 mg/m2, and ifosfamide 6 g/m2 (VIP) plus three cycles of high-dose carboplatin 1,500 mg/m2 and etoposide 1,500 mg/m2 (CE, arm A) or three cycles of VIP plus one cycle of high-dose carboplatin 2,200 mg/m2, etoposide 1,800 mg/m2, and cyclophosphamide 6,400 mg/m2 (CEC, arm B) followed by autologous stem-cell reinfusion. Long-term progression-free survival (PFS) and overall survival (OS) 6 years after random assignment of the last patient were compared by using the log-rank test. Results Overall, 108 and 103 patients were randomly assigned to arms A and B, respectivelyl. The study was stopped prematurely because of excess treatment-related mortality in arm B (14%) compared with that in arm A (4%; P = .01). As of December 2010, nine (5%) of 211 patients were lost to follow-up; 94 (45%) of 211 are alive and 88 (94%) of 94 patients are progression free. Five-year PFS is 47% (95% CI, 37% to 56%) in arm A and 45% (95% CI, 35% to 55%) in arm B (hazard ratio [HR], 1.16; 95% CI, 0.79 to 1.70; P = .454). Five-year OS is 49% (95% CI, 40% to 59%) in arm A and 39% (95% CI, 30% to 49%) in arm B (HR, 1.42; 95% CI, 0.99 to 2.05; P = .057). Conclusion Patients with relapsed or refractory GCT achieve durable long-term survival after single as well as sequential HDCT. Fewer early deaths related to toxicity translated into superior long-term OS after sequential HDCT.
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Affiliation(s)
- Anja Lorch
- Anja Lorch and Antje Kleinhans, University of Giessen and Marburg, Marburg; Christian K. Kollmannsberger, Jörg T. Hartmann, and Carsten Bokemeyer, Eberhard-Karls Universität, Tübingen; Jörg T. Hartmann, Universität Schleswig-Hostein, Kiel; Carsten Bokemeyer, University Clinic Eppendorf, Hamburg; Oliver Rick, Klinikum Reinhardshöhe, Bad Wildungen; Jörg Beyer, Vivantes Klinikum Am Urban, Berlin, Germany; Andrew Kramar, Centre Oscar Lambret, Lille, France; and Christian K. Kollmannsberger, British Columbia
| | - Antje Kleinhans
- Anja Lorch and Antje Kleinhans, University of Giessen and Marburg, Marburg; Christian K. Kollmannsberger, Jörg T. Hartmann, and Carsten Bokemeyer, Eberhard-Karls Universität, Tübingen; Jörg T. Hartmann, Universität Schleswig-Hostein, Kiel; Carsten Bokemeyer, University Clinic Eppendorf, Hamburg; Oliver Rick, Klinikum Reinhardshöhe, Bad Wildungen; Jörg Beyer, Vivantes Klinikum Am Urban, Berlin, Germany; Andrew Kramar, Centre Oscar Lambret, Lille, France; and Christian K. Kollmannsberger, British Columbia
| | - Andrew Kramar
- Anja Lorch and Antje Kleinhans, University of Giessen and Marburg, Marburg; Christian K. Kollmannsberger, Jörg T. Hartmann, and Carsten Bokemeyer, Eberhard-Karls Universität, Tübingen; Jörg T. Hartmann, Universität Schleswig-Hostein, Kiel; Carsten Bokemeyer, University Clinic Eppendorf, Hamburg; Oliver Rick, Klinikum Reinhardshöhe, Bad Wildungen; Jörg Beyer, Vivantes Klinikum Am Urban, Berlin, Germany; Andrew Kramar, Centre Oscar Lambret, Lille, France; and Christian K. Kollmannsberger, British Columbia
| | - Christian K. Kollmannsberger
- Anja Lorch and Antje Kleinhans, University of Giessen and Marburg, Marburg; Christian K. Kollmannsberger, Jörg T. Hartmann, and Carsten Bokemeyer, Eberhard-Karls Universität, Tübingen; Jörg T. Hartmann, Universität Schleswig-Hostein, Kiel; Carsten Bokemeyer, University Clinic Eppendorf, Hamburg; Oliver Rick, Klinikum Reinhardshöhe, Bad Wildungen; Jörg Beyer, Vivantes Klinikum Am Urban, Berlin, Germany; Andrew Kramar, Centre Oscar Lambret, Lille, France; and Christian K. Kollmannsberger, British Columbia
| | - Jörg T. Hartmann
- Anja Lorch and Antje Kleinhans, University of Giessen and Marburg, Marburg; Christian K. Kollmannsberger, Jörg T. Hartmann, and Carsten Bokemeyer, Eberhard-Karls Universität, Tübingen; Jörg T. Hartmann, Universität Schleswig-Hostein, Kiel; Carsten Bokemeyer, University Clinic Eppendorf, Hamburg; Oliver Rick, Klinikum Reinhardshöhe, Bad Wildungen; Jörg Beyer, Vivantes Klinikum Am Urban, Berlin, Germany; Andrew Kramar, Centre Oscar Lambret, Lille, France; and Christian K. Kollmannsberger, British Columbia
| | - Carsten Bokemeyer
- Anja Lorch and Antje Kleinhans, University of Giessen and Marburg, Marburg; Christian K. Kollmannsberger, Jörg T. Hartmann, and Carsten Bokemeyer, Eberhard-Karls Universität, Tübingen; Jörg T. Hartmann, Universität Schleswig-Hostein, Kiel; Carsten Bokemeyer, University Clinic Eppendorf, Hamburg; Oliver Rick, Klinikum Reinhardshöhe, Bad Wildungen; Jörg Beyer, Vivantes Klinikum Am Urban, Berlin, Germany; Andrew Kramar, Centre Oscar Lambret, Lille, France; and Christian K. Kollmannsberger, British Columbia
| | - Oliver Rick
- Anja Lorch and Antje Kleinhans, University of Giessen and Marburg, Marburg; Christian K. Kollmannsberger, Jörg T. Hartmann, and Carsten Bokemeyer, Eberhard-Karls Universität, Tübingen; Jörg T. Hartmann, Universität Schleswig-Hostein, Kiel; Carsten Bokemeyer, University Clinic Eppendorf, Hamburg; Oliver Rick, Klinikum Reinhardshöhe, Bad Wildungen; Jörg Beyer, Vivantes Klinikum Am Urban, Berlin, Germany; Andrew Kramar, Centre Oscar Lambret, Lille, France; and Christian K. Kollmannsberger, British Columbia
| | - Jörg Beyer
- Anja Lorch and Antje Kleinhans, University of Giessen and Marburg, Marburg; Christian K. Kollmannsberger, Jörg T. Hartmann, and Carsten Bokemeyer, Eberhard-Karls Universität, Tübingen; Jörg T. Hartmann, Universität Schleswig-Hostein, Kiel; Carsten Bokemeyer, University Clinic Eppendorf, Hamburg; Oliver Rick, Klinikum Reinhardshöhe, Bad Wildungen; Jörg Beyer, Vivantes Klinikum Am Urban, Berlin, Germany; Andrew Kramar, Centre Oscar Lambret, Lille, France; and Christian K. Kollmannsberger, British Columbia
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Haugnes HS, Laurell A, Stierner U, Bremnes RM, Dahl O, Cavallin-Ståhl E, Cohn-Cedermark G. High-dose chemotherapy with autologous stem cell support in patients with metastatic non-seminomatous testicular cancer - a report from the Swedish Norwegian Testicular Cancer Group (SWENOTECA). Acta Oncol 2012; 51:168-76. [PMID: 22175254 DOI: 10.3109/0284186x.2011.641507] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The SWENOTECA IV protocol from 1995 is a prospective population-based study in metastatic non-seminomatous germ cell testicular cancer (NSGCT), designed for early identification of patients with poor response to standard cisplatin-based chemotherapy. A slow tumor marker decline (HCG T(½) > 3 days, AFP T(½) > 7 days) after BEP or BEP plus ifosfamide was regarded as poor response. The aim of this study was to present survival and toxicity data for patients treated with high-dose chemotherapy (HDCT) within the SWENOTECA IV cancer care program. MATERIAL AND METHODS In total 882 adult men diagnosed with metastatic NSGCT between July 1995 and June 2007 in Sweden and Norway (except one center) were included in SWENOTECA IV and treated accordingly. Among these, 55 men (6.2%) were treated with HDCT according to three different indications in the protocol: A) poor response to standard-dose intensified chemotherapy (BEP plus ifosfamide); B) vital cancer at surgery after intensified chemotherapy; and C) selected relapses after previous chemotherapy. In situation A and C two HDCT cycles and in situation B one HDCT cycle was recommended. Situation A was the reason for HDCT in 36 patients, B in seven and C in 12 patients. The first HDCT cycle consisted of carboplatin 28 × (GFR + 25) mg, cyclofosfamide 6000 mg/m(2) and etoposide 1750 mg/m(2), administered over four days. In cycle two, etoposide was replaced by tiotepa 480 mg/m(2). RESULTS After a median follow-up of 7.5 years, overall survival was 72%, 100% and 58%, while failure-free survival was 64%, 71% and 42% in situation A, B and C, respectively. Three patients (5.5%) died during HDCT (renal failure or intracerebral hemorrhage). Nephrotoxicity was the most common non-hematological grade 4 toxicity (n = 5, 9%). CONCLUSION The population-based SWENOTECA strategy, selecting patients who do not respond adequately to primary standard-dose chemotherapy for immediate treatment intensification with HDCT, is feasible and might be advantageous.
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Horwich A, Daugaard G, Kollmannsberger C, Beyer J, Jewett MAS. Salvage therapy: SIU/ICUD Consensus Meeting on Germ Cell Tumors (GCT), Shanghai 2009. Urology 2011; 78:S469-74. [PMID: 21986226 DOI: 10.1016/j.urology.2011.03.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 03/08/2011] [Accepted: 03/08/2011] [Indexed: 11/19/2022]
Affiliation(s)
- Alan Horwich
- Department of Clinical Oncology, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, United Kingdom.
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Abstract
This article highlights relevant aspects of the rare late relapses of malignant germ cell tumors (MGCTs), which by definition occur at least 2 years after successful treatment. In most reports, 1% to 6% of patients with MGCT experience a late relapse. Surgery is the most important part in the treatment of late relapses. Viable MGCT or teratoma with malignant transformation may require multimodal treatment with chemotherapy, radiotherapy, and/or surgery. Salvage chemotherapy should be based on a representative biopsy. Referring patients with late relapse to high-volume institutions ensures the best chances of cure and enables multimodal treatment.
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Affiliation(s)
- Jan Oldenburg
- Department of Oncology, The Norwegian Radium Hospital, Oslo, Norway.
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Simonelli M, Rosti G, Banna GL, Pedrazzoli P. Intensified chemotherapy with stem-cell rescue in germ-cell tumors. Ann Oncol 2011; 23:815-22. [PMID: 21948814 DOI: 10.1093/annonc/mdr403] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Based on the high chemosensitivity of germ-cell tumors (GCTs), the concept of high-dose chemotherapy (HDCT) has been developed worldwide and investigated through many clinical trials. It has been carried out in different clinical settings, ranging from resistant or absolute refractory disease to chemosensitive relapse. HDCT with stem-cell support has been also explored as a part of first-line strategy for poor-prognosis patients. PATIENTS AND METHODS Our review summarized results from clinical trials evaluating the role of HDCT in patients with advanced GCTs. So far available data were obtained through a Medline search of English-language literature. RESULTS Several phase II trials and retrospective series have shown a possible benefit for GCT patients with recurrent disease as well as in first-line setting. Despite these results, data derived from randomized phase III studies failed to demonstrate any survival advantage for HDCT over conventional chemotherapy. CONCLUSIONS The role of HDCT in GCTs remains controversial. We need new prospective studies based on prognostic factors with multiple transplants of carboplatin and etoposide as the preferred high dose regimen. At present, based mainly on retrospective and phase II studies, HDCT may represent a therapeutic option for patients with primary refractory disease or for those with a second or further relapse.
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Affiliation(s)
- M Simonelli
- Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano.
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Nor Aripin KNB, Choonara I, Sammons HM. Systematic review of safety in paediatric drug trials published in 2007. Eur J Clin Pharmacol 2011; 68:189-94. [PMID: 21858432 PMCID: PMC3256313 DOI: 10.1007/s00228-011-1112-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 07/27/2011] [Indexed: 10/31/2022]
Abstract
BACKGROUND There is now greater involvement of children in drug trials to ensure that paediatric medicines are supported by sound scientific evidence. The safety of the participating children is of paramount importance. Previous research shows that these children can suffer moderate and severe adverse drug reactions (ADRs) in clinical trials, yet very few of the trials designated a data safety monitoring board (DSMB) to oversee the trial. METHODS Safety data from a systematic review of paediatric drug randomised controlled trials (RCTs) published in 2007 were analysed. All reported adverse events (AEs) were classified and assessed to determine whether an ADR had been experienced. ADRs were then categorised according to severity. Each trial report was examined as to whether an independent DSMB was in place. RESULTS Of the 582 paediatric drug RCTs analysed, 210 (36%) reported that a serious AE had occurred, and in 15% mortality was reported. ADRs were detected in more than half of the RCTs (305); 66 (11%) were severe, and 79 (14%) were moderate. Severe ADRs involved a wide range of organ systems and were frequently associated with cytotoxic drugs, antiparasitics, anticonvulsants and psychotropic drugs. Two RCTs reported significantly higher mortality rates in the treatment group. Only 69 (12%) of the RCTs stated there was a DSMB. DSMBs terminated five RCTs and changed the protocol in one. CONCLUSIONS Children participating in drug RCTs experience a significant amount and a wide range of ADRs. DSMBs are needed to ensure the safety of paediatric participants in clinical drug trials.
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Koychev D, Oechsle K, Bokemeyer C, Honecker F. Treatment of patients with relapsed and/or cisplatin-refractory metastatic germ cell tumours: an update. ACTA ACUST UNITED AC 2011; 34:e266-73. [DOI: 10.1111/j.1365-2605.2011.01145.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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