Advances in Urology / 2018 / Article / Tab 2

Review Article

Conventional-Dose versus High-Dose Chemotherapy for Relapsed Germ Cell Tumors

Table 2

Studies examining the use of high-dose chemotherapy as initial (or later) salvage therapy.

Author (Year)Study designNNotable I/E criteriaMedian f/u (m)HDCT as initial salvageHDCT regimenCyclesDurable CROS

Einhorn et al. [7]Retrospective184I: None
E: PM-NSGCT and late relapse
4873%Carboplatin 700 mg/m2 (d 1–3)
Etoposide 750 mg/m2 (d 1–3)
258% 2-year DFS65% at 5 years
Feldman et al. [8]Prospective, phase I/II107I: ≥1 adverse prognostic feature for salvage CDCTa
E: None
6176%Part A (TI): Paclitaxel 200 mg/m2 (d 1)
Ifosfamide 2000 mg/m2 (d 1–3)
248% 5-year DFS52% at 5 years
Part B (CE): Carboplatin AUC 7-8 (d 1–3) Etoposide 400 mg/m2 (d 1–3)3
Lorch et al. [20]Prospective, randomized phase III211I: None
E: None
9086%Arm A: VIP152% 2-year PFS50% at 5 years
Carboplatin 500 mg/m2 (d 1–3)
Etoposide 500 mg/m2 (d 1–3)
Arm B: VIP347% 2-year PFS40% at 5 years
Carboplatin 550 mg/m2 (d 1–4)
Etoposide 600 mg/m2 (d 1–4)
Cyclophosphamide 1600 mg/m2 (d 1–4)
Adra et al. [9]Retrospective364I: None
E: Late relapse
4083%Carboplatin 700 mg/m2 (d 1–3)
Etoposide 750 mg/m2 (d 1–3)
260% 2-year PFS66% at 2 years

I, inclusion; E, exclusion; HDCT, high-dose chemotherapy; f/u, follow-up; m, months; CR, complete response; OS, overall survival; PM-NSGCT, primary mediastinal nonseminomatous germ cell tumor; d, day; DFS, disease-free survival; AUC, area under the curve; PFS, progression-free survival; VIP, etoposide, ifosfamide, and cisplatin; aextragonadal primary site, incomplete response (IR) to first-line therapy, and PD after a salvage CDCT (cisplatin plus ifosfamide-based) regimen.