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

Table 3

Studies comparing the use of conventional-dose chemotherapy with high-dose chemotherapy as initial salvage therapy.

Author (Year)	Study design	Notable I/E criteria	Treatment regimen	NCDCT versus HDCT	Median f/u	PFS/EFS	OS
Beyer et al. [21]	Retrospective matched-pair analysis^a	I: NSGCT only; E: Pure seminoma	CDCT: Any; HDCT: VIP × 2–3 then 1 cycle ICE	55^b; 55^b	7.5y & 9y^c; 5y	HR 0.72–0.84^d	HR 0.77–0.83^d
Pico et al. [24]	Phase III randomized (IT-94)	I: none; E: IR to first-line therapy; pure seminoma treated with carboplatin	CDCT: VIP or VeIP × 4; HDCT: VIP or VeIP × 3 then CarboPEC × 1	128; 135	45 months	35% at 3y; 42% at 3y	47%; 47%
Lorch et al. [20]	Retrospective, including IPFSG subgroup analyses	I: ≥3 cycles of EP-based CT; E: cisplatin-refractory disease^e	CDCT: Any; HDCT: ≥1 cycle carboplatin + etoposide ± ifosfamide, thiotepa, or cyclophosphamide	773; 821	58 months	HR 0.44^d	HR 0.65^d

I, inclusion; E, exclusion; CDCT, conventional-dose chemotherapy; HDCT, high-dose chemotherapy; f/u, follow-up; PFS, progression-free survival; EFS, event-free survival; OS, overall survival; NSGCT, nonseminomatous germ cell tumor; VIP, etoposide, ifosfamide, and cisplatin; ICE, ifosfamide, carboplatin, and etoposide; y, years; HR, hazard ratio; CarboPEC, carboplatin, etoposide, and cyclophosphamide; IPFSG, International Prognostic Factor Study Group; ^amatching factors: primary tumor location, response to first-line treatment, duration of response, HCG and AFP levels; ^bfifty-five pairs of patients had full matches on >4 of 5 factors; ^cmedian follow-up for patients treated at Medical Research Council and Munich, respectively; ^dhazard ratio(s) favoring HDCT; ^eprogression within 4 weeks of the first-line cisplatin-based regimen.