Efficacy and safety of high-dose chemotherapy as the first or subsequent salvage treatment line in patients with relapsed or refractory germ cell cancer: an international multicentric analysis
- Author(s)
- Seidel, C; Schaefers, C; Connolly, EA; Weickhardt, A; Grimison, P; Wong, V; De Giorgi, U; Hentrich, M; Zschäbitz, S; Ochsenreither, S; Vincenzi, B; Oing, C; Bokemeyer, C; Engel, N; Alsdorf, W; Tran, B;
- Details
- Publication Year 2024-05,Volume 9,Issue #5,Page 103449
- Journal Title
- ESMO Open
- Publication Type
- Research article
- Abstract
- BACKGROUND: In relapsed or refractory (RR) metastatic germ cell cancer (GCC), high-dose (HD) chemotherapy (CTX) plus autologous stem cell transplantation is considered the standard of care. Limited data exist regarding the efficacy of HD-CTX following conventionally dosed salvage regimens (CDRs). This analysis explores and contrasts the efficacy of HD-CTX as the first or subsequent salvage regimen. PATIENTS AND METHODS: Data were retrospectively collected to explore the efficacy of HD-CTX administered as the first (group A) or subsequent salvage CTX (group B) after a CDR. The primary endpoint was OS from the time of HD-CTX. Associations of survival, overall response rate (ORR), and toxicity with clinical characteristics were explored using stratified Kaplan-Meier and Cox regression models. RESULTS: Overall, 283 patients with GCC were included from 11 international centers, with 159 patients (56%) in group A and 124 patients (44%) in group B. The first salvage treatment was administered between 1998 and 2022, with a median follow-up of 27.0 [standard deviation (SD) 46.2] months for group A and 17.0 (SD 48.5) months for group B. The median OS from HD-CTX treatment initiation was not reached in group A, compared with 25 months in group B (P = 0.00027), associated with 2- and 5-year OS rates of 74% and 63% (group A) versus 53% and 37% (group B), respectively. When administered as the first salvage treatment, HD-CTX was associated with a higher ORR (79% versus 60%; P = 0.013) and lower nonhematologic grade ≥3 toxicity rate (78% versus 97%; P < 0.001). Concerning risk factor analysis for the total cohort, the International Prognostic Factors Study Group score was the only independent predictor of OS in multivariable analysis (P = 0.006). CONCLUSIONS: When administered as the initial salvage treatment or after CDR, HD-CTX exhibits curative potential for patients with RR GCC. The efficacy and safety outcomes were more favorable when HD-CTX was conducted as the first salvage treatment line.
- Publisher
- Elsevier
- Keywords
- Humans; *Salvage Therapy/methods; Male; *Neoplasms, Germ Cell and Embryonal/drug therapy; Retrospective Studies; Adult; Middle Aged; Neoplasm Recurrence, Local/drug therapy; Antineoplastic Combined Chemotherapy Protocols/therapeutic use/adverse effects; Young Adult; Treatment Outcome; Female; conventional-dose salvage regimens; high-dose chemotherapy; refractory germ cell tumor; relapse; salvage chemotherapy
- Department(s)
- Medical Oncology
- Publisher's Version
- https://doi.org/10.1016/j.esmoop.2024.103449
- Open Access at Publisher's Site
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- Refer to copyright notice on published article.
Creation Date: 2024-07-18 03:28:03
Last Modified: 2024-07-18 03:32:48