Second-line chemotherapy in patients with relapsed extragonadal nonseminomatous germ cell tumors: Results of an international multicenter analysis

Purpose: Relapsed extragonadal germ cell tumors patients (EGGCT) are treate d with identical salvage chemotherapy regimens, as are patients with metast atic testicular cancer. This investigation evaluates the results of second- line chemotherapy in nonseminomatous EGGCT and tries to identify prognostic factors for survival. Patients and Methods: We conducted a retrospective review of 142 patients t reated at eleven European and American centers between 1975 and 1996. All h ad received cisplatin-containing regimens as induction treatment. Results: Twenty-seven of 142 patients (19%) were long-term disease-free, 11 % with primary mediastinal and 30% of patients with primary retroperitoneal disease. Median follow-up since start of salvage treatment was 11 months ( range, 1 to 157) for all patients and 45 months (range, 6 to 157) for survi ving patients. Forty-eight patients (34%) received high dose chemotherapy w ith autologous bone marrow transplant at relapse, and 10 of these patients (21%) are continuously disease-free. Primary mediastinal location (P =.003) , sensitivity to cisplatin (P =.003), elevated P-HCG at relapse (P =.04), a nd normal LDH at diagnosis (P =.01) were shown to be significant negative p rognostic factors for overall survival in univariate; mediastinal location [relative risk ratios (HR) = 1.9: 95% confidence intervals (CI), 1.2 to 3.0 ] and sensitivity to cisplatin [HR = 2.4; 95% CI, 1.1 to 5.2] were signific ant negative prognostic factors in multivariate analysis. Conclusion: Although current salvage strategies will cure between 20% and 5 0% of recurrent metastatic testicular cancer, relapsed nonseminomatous EGGC T patients appear to have an inferior survival rate, in particular in case of primary mediastinal location. Mediastinal primary tumor and inadequate r esponse to cisplatin-based induction chemotherapy have been identified as i ndependent negative prognostic factors, both associated with an approximate ly two-fold higher risk for failure of salvage treatment. (C) 2001 by Ameri can Society of Clinical Oncology.