New treatment combination for testicular cancer

Abstract

High-dose chemotherapy with carboplatin and etoposide followed by haemopoietic rescue with peripheral-blood stem-cell transplantation (PBSCT) is eff ective in recurrent testicular cancer (N Engl J Med 2007; 357: 340–48). “Switching to PBSCT [from bone marrow transplantation] reduced cost, converted [the procedure] to outpatient therapy, and allowed rapid haematological engraft ment, allowing the second course of high-dose chemotherapy to be given just 3–4 weeks after the fi rst course”, says author Lawrence Einhorn (Indiana University, Bloomington, IN, USA). The researchers analysed records from 184 patients with metastatic germ-cell tumours, who relapsed after receiving cisplatin-containing chemotherapy. 173 patients had received two courses of high-dose carboplatin (700 mg/m) and etoposide (750 mg/m) for 3 days, each followed by an infusion of stem cells. 11 patients received one course. 116 patients had com plete remission (median follow-up=48 months, range 14–118). 104 patients showed remission beyond 2 years. Remission was higher with high-dose chemotherapy used as second-line compared with third-line chemotherapy. “Since the potential to cure patients after they fail standard therapy without transplant is limited, the results off er hope in this young population of patients”, says Manish Kohli (University of Rochester Medical Center, NY, USA) “The report excludes the highest-risk patients with mediastinal primaries and cisplatin-refractory tumours”, says Guru Sonpavde (US Onco logy Research, Houston, TX, USA). “Studies in the past have shown durable response in this group with paclitaxel incorporated chemo therapy.” He continues, “conventional chemotherapy (paclitaxel, ifosfamide, cisplatin) has outcomes comparable to transplantation in relapsed patients with good risk. Therefore, the necessity of transplantation in a good risk population can only be answered with randomised trials”.