First-line high-dose chemotherapy compared with standard-dose PEB/VIP chemotherapy in patients with advanced germ cell tumors: A multivariate and matched-pair analysis

Purpose: To compare first-line high-dose chemotherapy (HD-CT) with autologo us broad stem-cell transplantation to standard-dose chemotherapy (SD-CT) in male patients with advanced germ cell tumors (GCTs), a matched-pair analys is was performed within a homogenous group of patients classified as having either Indiana advanced disease or a poor prognosis according to Internati onal Germ Cell Cancer Consensus Group (IGCCCG) criteria, Patients and Methods: A multivariate analysis was performed that included 1 47 consecutive patients who herd received sequential high-dose cisplatin, e toposide, and ifosfamide (VIP) therapy (HD-CI) in a German multicenter tria l between 1993 and 1997 and 309 patients who had been treated with standard -dose cisplatin, etoposide, and bleomycin (PEB) or VIP chemotherapy (SD-CT) within two randomized trials at Indiana University between 1984 and 1992. Results: Multivariate analysis demonstrated HD-CT to be significantly super ior to SD-CT when adjustments were made for prognostic factors (P = .021). Primary tumor sire (mediastinal v retroperitoneal/gonadal, P = .035) and pr esence of visceral metastases (P = .0004) were shown to be significant prog nostic factors for overall survivor, On the basis of these factors, as well as on tumor marker levels (good, intermediate, or poor, according to IGCCC G criteria), 146 of 147 HD-CT patients were fury matched to an SD-CT patien t. Median follow-up was 21 months (range, 0 to 70 months) for the HD-CT pat ients and 22 months (range, 0 to 90 months) for the SD-CT patients, Two-yea r progression-free survival (75% v 59%) and overall survival (82% v 71%) we re significantly prolonged in HD-CT patients (P = .0056 and P = .0184, resp ectively). Conclusion: The results indicate that first-line HD-CT in patients with poo r-prognosis GCT may result in a significant improvement of progression-free and overall survival as compared with SD-CT, Salvage HD-CT seems not to co mpensate this survival advantage, (C) 1999 by American Society of Clinical Oncology.