Should high-dose chemotherapy be used to consolidate second or third line treatment in relapsing germ cell tumours?

Thirty consecutive patients with relapsing germ cell tumours (GCT) were tre ated with induction chemotherapy and high-dose chemotherapy consolidation ( HDCT). Overall, 47% were progressionfree and 53% were alive with a median f ollow up of 40 months. Initially, HDCT was given as consolidation of third line VIP (etoposide/ifosfamide and cisplatin), following failure of a weekl y cisplatin regimen. During 1995, paclitaxel was introduced into second lin e therapy with cisplatin and ifosfamide (TIP), with immediate consolidation using HDCT. At the same time the carboplatin dosing calculation was change d and an area under the curve (AUC) formula rather than by mg/m(2) was used to calculate this. The main determinant of post-treatment renal dysfunctio n was pretreatment renal function rather than the AUC dose of carboplatin. Only a raised LDH prior to induction or absolute refractory disease in resp onse to induction chemotherapy predicted poor survival following HDCT. In p atients relapsing following HDCT, the outcome was poor with many patients r elapsing in the central nervous system and other new sites of disease. Furt her responses were seen to chemotherapy or radiotherapy but these were not sustained. The failure to improve results when HDCT was used as second line rather than third line chemotherapy consolidation was disappointing and ad ds to further uncertainty of the role of this approach as far as timing and the ideal preparative regimen are concerned.