Advances in Urology / 2018 / Article / Tab 3

Review Article

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 designNotable I/E criteriaTreatment regimenNCDCT versus HDCTMedian f/uPFS/EFSOS

Beyer et al. [21]Retrospective matched-pair analysisaI: NSGCT only
E: Pure seminoma
CDCT: Any
HDCT: VIP × 2–3 then 1 cycle ICE
55b
55b
7.5y & 9yc
5y
HR 0.72–0.84dHR 0.77–0.83d
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 months35% at 3y
42% at 3y
47%
47%
Lorch et al. [20]Retrospective, including IPFSG subgroup analysesI: ≥3 cycles of EP-based CT
E: cisplatin-refractory diseasee
CDCT: Any
HDCT: ≥1 cycle carboplatin + etoposide ± ifosfamide, thiotepa, or cyclophosphamide
773
821
58 monthsHR 0.44dHR 0.65d

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.