Cisplatin, etoposide, and ifosfamide salvage therapy for refractory or relapsing germ cell carcinoma

Cisplatin, etoposide, and ifosfamide salvage therapy for refractory or relapsing germ cell carcinoma

Thirty patients with metastatic progressive germ cell carcinoma who failed to be cured with first-line cisplatin chemotherapy were treated with a salvage regimen consisting of cisplatin 20 mg/m2, etoposide 100 mg/m2, and ifosfamide 1.2 g/m2 (PEI) intravenously (IV), days 1 to 5 every 3 weeks. Ten pa...

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Bibliographic Details
Published in:Journal of clinical oncology Vol. 9; no. 9; p. 1549
Main Authors: Harstrick, A, Schmoll, H J, Wilke, H, Köhne-Wömpner, C H, Stahl, M, Schöber, C, Casper, J, Bruderek, L, Schmoll, E, Bokemeyer, C
Format: Journal Article
Language:English
Published: United States 01-09-1991
Subjects:
Adult
Antineoplastic Combined Chemotherapy Protocols - adverse effects
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Cisplatin - administration & dosage
Combined Modality Therapy
Drug Administration Schedule
Etoposide - administration & dosage
Humans
Ifosfamide - administration & dosage
Infusions, Intravenous
Male
Neoplasms, Germ Cell and Embryonal - drug therapy
Neoplasms, Germ Cell and Embryonal - surgery
Prognosis
Recurrence
Survival Rate
Testicular Neoplasms - drug therapy
Testicular Neoplasms - surgery
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Summary:Thirty patients with metastatic progressive germ cell carcinoma who failed to be cured with first-line cisplatin chemotherapy were treated with a salvage regimen consisting of cisplatin 20 mg/m2, etoposide 100 mg/m2, and ifosfamide 1.2 g/m2 (PEI) intravenously (IV), days 1 to 5 every 3 weeks. Ten patients (33%) were tumor-free at the end of therapy. Complete response (CR) was achieved with chemotherapy alone in four patients and with additional surgery in six patients (two necroses, two mature teratomas, two carcinomas). Six patients (20%) had normalization of tumor markers but unresectable residual disease (Rm-), and the remaining 14 patients (46%) failed to respond. Of 10 patients with CR, nine (90%) relapsed again (eight carcinomas, one mature teratoma). The median duration of CR was 3.5 months. The median survival of the whole group was 311 days (range, 110 to 996+). Currently, seven of 30 patients are alive, and five of them are without signs of progressive tumor. The response to prior cisplatin therapy predicted for response and survival after PEI salvage therapy. Of 14 patients with prior CR, eight (57%) achieved a second CR compared with one of 11 (9%) with prior unfavorable response (P = .039). The median survival for patients with prior favorable response was 400 days, compared with 251 days for patients with prior unfavorable response (P less than .001). Myelosuppression was dose-limiting, with leukopenia greater than grade 2 in 84% and thrombocytopenia greater than grade 2 in 51% of all cycles. This three-drug regimen can induce a second CR in one third of patients with relapsed or refractory germ cell carcinoma. Only those patients with prior favorable responses can expect to be cured by this salvage regimen, while patients with prior unfavorable response should be considered for alternative salvage approaches.
ISSN:0732-183X
DOI:10.1200/JCO.1991.9.9.1549