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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MSK Authors
  1. Dean Bajorin
    603 Bajorin
  2. Robert Motzer
    1079 Motzer
  3. Madhu Mazumdar
    127 Mazumdar
  4. George Bosl
    421 Bosl
  5. Vaia   Vlamis
    38 Vlamis