Double dose-intensive chemotherapy with autologous stem cell support for relapsed and refractory testicular cancer: the University of Michigan experience and literature review

Testicular cancer patients refractory or in relapse after primary chemother apy have less than or equal to 25% 5-year progression-free survival with sa lvage. To improve prognosis, patients entered a phase I/II tandem dose-esca lation trial of carboplatin (1500-2100 mg/m(2)) and etoposide (1200-2250 mg /m(2)) with ABMT, Patients were eligible for a second cycle if disease prog ression was absent and performance status allowed. From August 1990 to June 1998, 29 males (25 NSGCT) were treated. At the time of ABMT, 10 were chemo sensitive, four were chemoresistant, and 10 were absolutely refractory to p latinum. Disease status (no, patients) at transplant: primary refractory di sease (six), first relapse (10), second relapse (eight), third relapse (fiv e). Fifteen (52%) received both transplants. Treatment-related mortality wa s 10%. Best response after ABMT included: two CR, one CR surgically NED, fi ve PR, three PR surgically NED, seven SD, and eight PD, Eight (28%) patient s are continuously progression-free a median 60 months (range, 31-93) from first ABMT. Three seminoma patients remain progression-free. Of five long-t erm NSGCT survivors, four were treated in first relapse with platinum-sensi tive disease, Eighteen relapses occurred a median of 4 months after ABMT I (two late relapses at 28 and 44 months), The median PFS and OS for the whol e group are 4 and 14 months, respectively. Patients with relapsed/refractor y testicular cancer benefit most from ABMT if they have platinum-sensitive disease in first relapse. Patients who do poorly despite ABMT have a medias tinal primary site, true cisplatin-refractory disease, disease progression prior to ABMT, and/or markedly elevated beta HCG at ABMT. New treatment mod alities are needed for the latter group.