High-dose carboplatin, etoposide, and cyclophosphamide with autologous bone marrow transplantation in first-line therapy for patients with poor- risk germ cell tumors Journal Article
| Authors: | Motzer, R. J.; Mazumdar, M.; Bajorin, D. F.; Bosl, G. J.; Lyn, P.; Vlamis, V. |
| Article Title: | High-dose carboplatin, etoposide, and cyclophosphamide with autologous bone marrow transplantation in first-line therapy for patients with poor- risk germ cell tumors |
| Abstract: | Purpose: A treatment program that included highdose carboplatin, etoposide, and cyclophosphamide (CEC) followed by autologous bone marrow transplantation (AuBMT) was investigated as first-line therapy in patients with poor-risk germ cell tumors (GCTs). Patients and Methods: Previously untreated GCT patients with poor-risk features were treated with etoposide, ifosfamide, and cisplatin (VIP) with or without highdose CEC plus AuBMT. Patients qualified far a change to high-dose CEC if a prolonged clearance of elevated serum tumor markers was observed after two cycles of the cisplatin- containing regimen. Results: Sixteen patients were treated with VIP alone and 14 with VIP and high-dose CEC. Seventeen patients (57%) achieved a complete response. Twenty are alive (67%) and 15 (50%) are free of disease at a median follow-up time of 30 months. Far 23 cycles of high-dose CEC, the median time from AuBMT to a granulocyte count 0.5/μL was 11 days (range, 0 to 14) and to a platelet count 50,000/μL, 19 days (range, 14 to 34). The survival of 58 patients treated in two of our center's programs that incorporated high-dose chemotherapy (high-dose carboplatin plus etoposide [CE] and CEC) was compared with our prior experience with conventional-dose cisplatin chemotherapy alone in poor-risk GCT. Patients treated with marker- dependent, early-intervention highdose chemotherapy experienced longer survival (P = .001). Conclusion: In this setting, high-dose CEC was well tolerated, cumulative toxicity was lacking, and the recovery of blood counts after AuBMT was rapid. A randomized trial has been initiated to investigate further the role of high-dose CEC in first-line therapy far patients with poor-risk GCT. |
| Keywords: | adolescent; adult; cancer survival; clinical article; treatment outcome; clinical trial; cancer combination chemotherapy; combined modality therapy; carboplatin; bone marrow suppression; etoposide; antineoplastic combined chemotherapy protocols; drug administration schedule; cyclophosphamide; testicular neoplasms; retroperitoneal neoplasms; bone marrow transplantation; germ cell tumor; mediastinal neoplasms; drug tolerance; transplantation, autologous; autologous bone marrow transplantation; germinoma; humans; human; male; priority journal; article |
| Journal Title: | Journal of Clinical Oncology |
| Volume: | 15 |
| Issue: | 7 |
| ISSN: | 0732-183X |
| Publisher: | American Society of Clinical Oncology |
| Date Published: | 1997-06-01 |
| Start Page: | 2546 |
| End Page: | 2552 |
| Language: | English |
| PUBMED: | 9215823 |
| PROVIDER: | scopus |
| DOI: | 10.1200/JCO.1997.15.7.2546 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 17 March 2017 -- Source: Scopus |
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