|
|
 | |||||||||||||||||||||||||||||||||||||||||||||||
 | |||||||||||||||||||||||||||||||||||||||||||||||
| |||||||||||||||||||||||||||||||||||||||||||||||
Background Metastatic testicular tumors that have not been successfully treated by means of initial chemotherapy are potentially curable with salvage chemotherapy.
Methods We conducted a retrospective review of 184 consecutive patients with metastatic testicular cancer that had progressed after they received cisplatin-containing combination chemotherapy. We gave 173 patients two consecutive courses of high-dose chemotherapy consisting of 700 mg of carboplatin per square meter of body-surface area and 750 mg of etoposide per square meter, each for 3 consecutive days, and each followed by an infusion of autologous peripheral-blood hematopoietic stem cells; the other 11 patients received a single course of this treatment. In 110 patients, cytoreduction with one or two courses of vinblastine plus ifosfamide plus cisplatin preceded the high-dose chemotherapy.
Results Of the 184 patients, 116 had complete remission of disease without relapse during a median follow-up of 48 months (range, 14 to 118). Of the 135 patients who received the treatment as second-line therapy, 94 were disease-free during follow-up; 22 of 49 patients who received treatment as third-line or later therapy were disease-free. Of 40 patients with cancer that was refractory to standard-dose platinum, 18 were disease-free. A total of 98 of 144 patients who had platinum-sensitive disease were disease-free, and 26 of 35 patients with seminoma and 90 of 149 patients with nonseminomatous germ-cell tumors were disease-free. Among the 184 patients, there were three drug-related deaths during therapy. Acute leukemia developed in three additional patients after therapy.
Conclusions Testicular tumors are potentially curable by means of high-dose chemotherapy plus hematopoietic stem-cell rescue, even when this regimen is used as third-line or later therapy or in patients with platinum-refractory disease.
Source Information
From the Division of Hematology–Oncology, Indiana University School of Medicine (L.H.E., S.D.W., A.C., M.J.B., R.A.); the Walther Cancer Institute (L.H.E., S.D.W., A.C., M.J.B., R.A.); and the Division of Biostatistics, Indiana University (S.M.P.) — all in Indianapolis.
Address reprint requests to Dr. Einhorn at the Indiana University Cancer Center, 535 Barnhill Dr., Rm. 473, Indianapolis, IN 46202-5289, or at leinhorn{at}iupui.edu.
Related Letters:
Germ-Cell Tumors
Shamash J., Stebbing J., Powles T., Lorch A., Beyer J., Bokemeyer C., Kondagunta V., Galsky M. D., Sonpavde G., De Giorgi U., Pedrazzoli P., Rosti G., the Italian Germ-Cell Cancer Group and Gruppo Italiano per il Trapianto di Midollo Osseo, Cellule Staminali Emopoietiche e Terapia Cellulare , Einhorn L. H.
Extract |
Full Text |
PDF
N Engl J Med 2007;
357:1771-1774, Oct 25, 2007.
Correspondence
This article has been cited by other articles:
HOME | SUBSCRIBE | SEARCH | CURRENT ISSUE | PAST ISSUES | COLLECTIONS | PRIVACY | HELP | beta.nejm.org Comments and questions? Please contact us. The New England Journal of Medicine is owned, published, and copyrighted © 2008 Massachusetts Medical Society. All rights reserved. |
Previous
