High-dose chemotherapy with hematopoietic stem-cell support in germ-cell tumor patient treatment: The French experience

Germ-cell tumors (GCTs) are very chemosensitive and highly curable cancers. For the small proportion of patients who fail conventional chemotherapy (C T), high-dose CT (HDCT) was introduced in France and elsewhere in 1982-1984 . We report here on the French experience with HDCT in GCTs. At the Centre Leon Berard, 75 patients were treated with HDCT between 1982 and 1996. Pati ents received HDCT in 2 different settings: 46 in consolidation of first-li ne treatment or in incomplete response, 29 in salvage of relapse or refract ory disease. The most common regimens of HDCT were the combination of etopo side, double-dose cisplatin and either ifosfamide (VIC regimen, n = 46) or cyclophosphamide (PEC regimen, n = 9) and the combination of carboplatin, e toposide and cyclophosphamide (Carbo-PEC regimen, n = 17), Seven patients d ied of toxicity. The median follow-up was 42 months. Forty-five of 75 patie nts are alive and free of disease at long term, 2 of whom had refractory di sease. The median time to recovery of a granulocyte count greater than or e qual to 0.5 x 10(9)/1 and a platelet count greater than or equal to 25 x 10 (9)/1 was 14 and II days, respectively. The French development was based on double-dose cisplatin until the results of the French randomized trial, wh ich showed no advantage of HDCT in the first-line treatment of poor-risk gr oup patients. Then carboplatin was associated with etoposide and cyclophosp hamide in a phase I trial. A European randomized trial, which studies the r ole of HDCT in the first-line salvage treatment of non-refractory disease, is ongoing. So far, HDCT is not a standard treatment of GCT. (C) 1999 Wiley -Liss, Inc.