Salvage chemotherapy with high-dose carboplatin and etoposide (HDCE) with peripheral blood stem cell transplant (PBSCT) in patients with relapsed seminoma

Abstract

5054 Background: Patients with relapsed seminoma are treated with salvage chemotherapy. Current therapeutic options include cisplatin plus ifosfamide based regimens or high dose chemotherapy with PBSCT. At Indiana University HDCE was usually reserved for third line therapy for relapsed seminoma, unless there were visceral metastases or relapse within 3 months of initial chemotherapy. Methods: Retrospective review of 35 consecutive patients with pure seminoma (median 38 yrs; range 23–56 yrs) that received HDCE with PBSCT from 2/96–12/04. Cytoreductive chemotherapy with 0–2 courses of vinblastine, ifosfamide, and cisplatin (VeIP) preceeded HDCE. Carboplatin dosage was 700mg/m2 for 3 days plus etoposide 750mg/m2 for 3 days. A second course of therapy was given after hematopoietic recovery. Results: Treatment related mortality was seen only in patients that received two or more prior regimens (median age 45 yrs, range 27–56 yrs) and occurred in 4/35 (11%) patients. One man died of AML at 62 months (see table below). 26/35 (74%) are continuously NED (cNED). 15/35 patients received 1 prior regimen and 14/15 (93%) are cNED. 20/35 patients received =2 prior regimens and 12/20 (60%) are NED. 14/35 patients had prior XRT. 10/14 (71%) are cNED. 6/14 patients had prior XRT and =2 prior regimens and 3/6 (50%) are NED. Conclusions: HDCE with PBSCT has a high cure rate even when used as 3rd line or later therapy. Because of the 93% continuous NED rate when used as 2nd line therapy and the increased treatment related mortality when used as 3rd line therapy we now recommend HDCE as initial salvage therapy. [Table: see text] No significant financial relationships to disclose.