High-dose chemotherapy with hematopoietic stem-cell support in germ-cell tumor patient treatment: The French experience

Abstract

Germ-cell tumors (GCTs) are very chemosensitive and highly curable cancers. For the small proportion of patients who fail conventional chemotherapy (CT), high-dose CT (HDCT) was introduced in France and elsewhere in 1982-1984. We report here on the French experience with HDCT in GCTs. At the Centre Léon Bérard, 75 patients were treated with HDCT between 1982 and 1996. Patients received HDCT in 2 different settings: 46 in consolidation of first-line treatment or in incomplete response, 29 in salvage of relapse or refractory disease. The most common regimens of HDCT were the combination of etoposide, double-dose cisplatin and either ifosfamide (VIC regimen, n = 46) or cyclophosphamide (PEC regimen, n = 9) and the combination of carboplatin, etoposide and cyclophosphamide (Carbo-PEC regimen, n = 17). Seven patients died of toxicity. The median follow-up was 42 months. Forty-five of 75 patients are alive and free of disease at long term, 2 of whom had refractory disease. The median time to recovery of a granulocyte count > or = 0.5 x 10(9)/l and a platelet count > or = 25 x 10(9)/l was 14 and 11 days, respectively. The French development was based on double-dose cisplatin until the results of the French randomized trial, which showed no advantage of HDCT in the first-line treatment of poor-risk group patients. Then carboplatin was associated with etoposide and cyclophosphamide in a phase I trial. A European randomized trial, which studies the role of HDCT in the first-line salvage treatment of non-refractory disease, is ongoing. So far, HDCT is not a standard treatment of GCT.