Clinical outcome of germ cell cancer patients (pts) treated with high-dose chemotherapy with stem cell support (HDC) –a single center experience

Abstract

4724 Background: Pts with International Germ Cell Cancer Collaborative Group (IGCCCG) “poor prognosis” disease achieve only a 41% 5-year progression-free survival (PFS) with standard chemotherapy. Pts who do not achieve a complete remission with BEP chemotherapy or who relapse after such treatment have a still worse prognosis. The clinical impact of HDC in such pts is still unclear. Methods: Pts with germ cell cancer with IGCCCCG “poor prognosis” disease at diagnosis (or, earlier, with Indiana group C) or with recurrent or refractory (i.e., less than marker negative partial remission) disease after initial BEP chemotherapy were eligible for HDC. Results: Between June 1996 and April 2003, 18 pts underwent one (13 pts) or two (5 pts) cycles of HDC with ICE (ifosfamide 10g/m2, carboplatin 1,500mg/m2 and etoposide 2,400mg/m2); 17 pts), or etoposide (1500mg/m2) plus thiotepa (900 mg/m2); 1 pt), in 6 pts as consolidation after BEP and in 12 pts for recurrent disease (7 pts) or refractoriness to BEP (5 pts). In the consolidation group (6 pts), with a median follow-up of 42 months (range 10–72 months), there are no events. Thus the PFS and overall survival (OS) at 3.5 years is 100%. In contrast, with a median follow-up of 18 months, the median PFS and OS for pts with recurrent or refractory disease subgroup are 4 months (0–40+) and 18 months (4–40+), respectively. In this subgroup, 10 pts relapsed by 8 months post-HDC and only 2 are progression-free at 20 and 40 months. Conclusions: Despite the small number of pts and short follow-up, these results compare at least as favorably to the outcome obtained with standard chemotherapy in pts with “poor prognosis” at diagnosis. In contrast the outcome of pts with recurrent or refractory disease after initial BEP chemotherapy are not better than those obtained with standard salvage chemotherapy. No significant financial relationships to disclose.