High Dose Chemotherapy with Autologous Marrow Rescue for Germ Cell Salvage Consolidation: Vancouver Experience

Abstract

This chapter focuses on high-dose chemotherapy with antilogous marrow rescue for germ cell salvage consolidation. The overall outcome for patients with metastatic germ cell testis cancers is remarkably good with cisplatin-based combination chemotherapy. Two categories of patients are appropriate to consider for experimental approaches: (1) those with extremely adverse prognostic factors at presentation and (2) those whose cancer has recurred despite standard cisplatin-based chemotherapy. Patients who recur despite initial intensive treatment are usually beyond cure with chemotherapy but may be salvaged surgically if the problem is growing teratoma or localized drug resistant disease. A total of 22 Vancouver patients with germ cell cancers are assessable for toxicity associated with high-dose chemotherapy regimens. Peripheral neuropathy was mostly attributable to cisplatin in the induction phase and was incapacitating in one patient who made a full recovery. High-dose chemotherapy with carboplatin, etoposide, and cyclophosphamide with antilogous bone marrow rescue appears to have the potential to improve the results of difficult germ cell cancers.