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Efficacy and safety of high-dose chemotherapy as the first or subsequent salvage treatment line in patients with relapsed or refractory germ cell cancer: an international multicentric analysis

Background - In relapsed or refractory (RR) metastatic germ cell cancer (GCC), high-dose (HD) chemotherapy (CTX) plus autologous stem cell transplantation is considered the standard of care. Limited data exist regarding the efficacy of HD-CTX following conventionally dosed salvage regimens (CDRs). T...

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Main Authors: Seidel, Christoph (Author) , Schaefers, C. (Author) , Connolly, E. A. (Author) , Weickhardt, A. (Author) , Grimison, P. (Author) , Wong, V. (Author) , De Giorgi, U. (Author) , Hentrich, M. (Author) , Zschäbitz, Stefanie (Author) , Ochsenreither, S. (Author) , Vincenzi, B. (Author) , Oing, C. (Author) , Bokemeyer, C. (Author) , Engel, N. (Author) , Alsdorf, W. (Author) , Tran, B. (Author)
Format: Article (Journal)
Language:English
Published: 13 May 2024
In: ESMO open
Year: 2024, Volume: 9, Issue: 5, Pages: 1-6
ISSN:2059-7029
DOI:10.1016/j.esmoop.2024.103449
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.esmoop.2024.103449
Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S2059702924012171
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Author Notes:C. Seidel, C. Schaefers, E.A. Connolly, A. Weickhardt, P. Grimison, V. Wong, U. De Giorgi, M. Hentrich, S. Zschäbitz, S. Ochsenreither, B. Vincenzi, C. Oing, C. Bokemeyer, N. Engel, W. Alsdorf & B. Tran
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Summary:Background - In relapsed or refractory (RR) metastatic germ cell cancer (GCC), high-dose (HD) chemotherapy (CTX) plus autologous stem cell transplantation is considered the standard of care. Limited data exist regarding the efficacy of HD-CTX following conventionally dosed salvage regimens (CDRs). This analysis explores and contrasts the efficacy of HD-CTX as the first or subsequent salvage regimen. - Patients and methods - Data were retrospectively collected to explore the efficacy of HD-CTX administered as the first (group A) or subsequent salvage CTX (group B) after a CDR. The primary endpoint was OS from the time of HD-CTX. Associations of survival, overall response rate (ORR), and toxicity with clinical characteristics were explored using stratified Kaplan-Meier and Cox regression models. - Results - Overall, 283 patients with GCC were included from 11 international centers, with 159 patients (56%) in group A and 124 patients (44%) in group B. The first salvage treatment was administered between 1998 and 2022, with a median follow-up of 27.0 [standard deviation (SD) 46.2] months for group A and 17.0 (SD 48.5) months for group B. The median OS from HD-CTX treatment initiation was not reached in group A, compared with 25 months in group B (P = 0.00027), associated with 2- and 5-year OS rates of 74% and 63% (group A) versus 53% and 37% (group B), respectively. When administered as the first salvage treatment, HD-CTX was associated with a higher ORR (79% versus 60%; P = 0.013) and lower nonhematologic grade ≥3 toxicity rate (78% versus 97%; P < 0.001). Concerning risk factor analysis for the total cohort, the International Prognostic Factors Study Group score was the only independent predictor of OS in multivariable analysis (P = 0.006). - Conclusions - When administered as the initial salvage treatment or after CDR, HD-CTX exhibits curative potential for patients with RR GCC. The efficacy and safety outcomes were more favorable when HD-CTX was conducted as the first salvage treatment line.
Item Description:Online verfügbar: 13. Mai 2024, Artikelversion: 13. Mai 2024
Gesehen am 05.12.2024
Physical Description:Online Resource
ISSN:2059-7029
DOI:10.1016/j.esmoop.2024.103449

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