Long term survival of patients with recurrent or refractory germ cell tumors after high dose chemotherapy

BACKGROUND. The optimal treatment of patients with recurrent or refractory germ cell tumors is still a debated topic. High dose chemotherapy (HDCT) with autologous stem cell rescue (ASCR) might be promising for intensification of first or subsequent salvage treatment. However, the long term results of this approach remain largely unknown. METHODS, Between August 1989 and September 1992, 74 patients with recurrent and/or refractory germ cell tumors were treated in a Phase I/II trial with HDCT consisting of carboplatin (1500-2000 mg/m(2)), etoposide (1200-2400 mg/m(2)), and ifosfamide (0-10 g/m(2)). In September 1995 all patients were reevaluated to determine overall response, late toxicities, and survival. RESULTS. Two patients died from treatment-related toxicity shortly after HDCT, and 47 had recurrence or progression of disease after a median of 3 months (range, 1-44 months). Of these latter patients, three were living continuously disease free at the conclusion of this study after a second HDCT regimen, salvage surgery, or chronic oral etoposide treatment. The results were an overall survival of 38% (95% confidence interval, 27-50%) and a failure free survival of 31% (95% confidence interval, 21-43%) at 5 years. There were no long term survivors among patients whose disease progressed while they were receiving conventional doses of cisplatin before HDCT. Late toxicities consisted mainly of renal impairment (in 21% of patients), paresthesias (in 29%), and ototoxicity (in 18%). CONCLUSIONS. HDCT can be curative for patients with germ cell tumors who do not become disease free after conventional dose chemotherapy but respond to this treatment. (C) 1997 American Cancer Society.