Results of treatment after relapse from high-dose chemotherapy in germ cell tumors

Purpose: To identify therapy-related or patient-related characteristics tha t predict response and longterm survival after failure of high-dose chemoth erapy (HDCT) for germ cell tumors (GCT). Patients and Methods: Between 1986 and 1997, 101 GCT patients relapsed afte r high-dose carboplatin and etoposide (VP-16) at Indiana University (Indian apolis, IN). Median time to relapse was 10 months (range, 1 to 17 months). HDCT was the first salvage treatment in 29 patients and second or later sal vage treatment in 72 patients. Results: Fifty-four of 101 patients received post-HDCT treatment. Of these, 47 received chemotherapy, alone (n = 35) or In combination with surgery (n = 12). Seven patients underwent surgery alone. There were only 12 objectiv e responses (three complete and nine partial responses) for 66 chemotherapy regimens given to 47 patients, for an overall response rate of 18.2%. Fift een patients received platinum-based chemotherapy, with only one objective response. Chemotherapy was discontinued in 17% of Eases because of toxicity . A longer interval between HDCT and post-HDCT treatment was the only varia ble that was associated with response. Five patients (4.9%) are disease-fre e at 30, 53, 57, 85, and 93 months after relapse. Of these, three responded to oral VP-16 and underwent resection of residual mediastinal, retroperito neal, and inguinal cancer, respectively. One had resection of residual medi astinal yolk sac tumor, followed by oral VP-16. One relapsed with teratoma and received thoracoabdominal resection without chemotherapy, Conclusion: Patients who experience disease progression after HDCT often re ceive further chemotherapy and/or surgery. Chemotherapy resulted in a respo nse rare of less than 20%, with only three complete responses. All of the l ong-term survivors (4.9%) had surgery as a component of their post-HDCT reg imen. (C) 2000 by American Society of Clinical Oncology.