Journal of Clinical Oncology, Vol 21, Issue 22
(November), 2003: 4100-4104
© 2003 American Society for Clinical Oncology
Long-Term Survival After High-Dose Salvage Chemotherapy for Germ Cell Malignancies With Adverse Prognostic Variables
Daniel A. Vaena,
Rafat Abonour,
Lawrence H. Einhorn
From the Division of Hematology-Oncology, Indiana University School of Medicine and Walther Cancer Institute, Indianapolis, IN.
Address reprint requests to Lawrence H. Einhorn, MD, Indiana University Cancer Center, 535 Barnhill Dr, Rm 473, Indianapolis, IN 46202; e-mail: leinhorn{at}iupui.edu.
Purpose: Independent prognostic variables for patients undergoing high-dose chemotherapy (HDCT) as salvage modality for germ cell tumors (GCT) were previously described, and a score was created. Patients with more than 2 points had a poor prognosis. However, these data were from patients treated from 1984 to 1993, and most received a single HDCT course. In this study, we evaluated outcomes at Indiana University and determined the applicability of the Beyer score to contemporary poor-risk patients.
Patients and Methods: We performed a retrospective analysis of patients who received salvage HDCT between 1988 and 2001 and had at least one of the following characteristics: platinum-refractory or absolutely platinum-refractory GCT, primary mediastinal nonseminomatous GCT (PMNSGCT), human chorionic gonadotropin (HCG)  1,000 mU/mL or alpha-fetoprotein (AFP) 1,000 ng/mL before HDCT. Primary end points were overall and 2-year failure-free survival (FFS).
Results: Eighty patients were identified. Fifty-six were platinum refractory, 23 had a Beyer score greater than 2, and 13 had PMNSGCT. Fifty-six patients received two HDCT courses. HDCT included carboplatin and etoposide. Forty-three patients received HDCT as first salvage modality. Median overall survival was 14.7 months. The 2-year FFS was 32%. No relapses have occurred after 2 years from HDCT. Patients with greater than 2 points in the Beyer score, platinum-refractory patients, and patients with HCG 1,000 mU/mL, AFP 1,000 ng/mL, and PMNSGCT had 2-year FFS of 30%, 37%, 26%, 18%, and 0%, respectively.
Conclusion: Results with PMNSGCT remained poor. However, other patients with poor prognosis should not be denied an attempt at curative salvage HDCT.
Presented in part at the 39th Annual Meeting of the American Society of Clinical Oncology, Chicago, IL, May 31–June 3, 2003.
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