High-dose carboplatin, etoposide, and cyclophosphamide for patients with refractory germ cell tumors: Treatment results and prognostic factors for survival and toxicity Journal Article

Authors: Motzer, R. J.; Mazumdar, M.; Bosl, G. J.; Bajorin, D. F.; Amsterdam, A.; Vlamis, V.
Article Title: High-dose carboplatin, etoposide, and cyclophosphamide for patients with refractory germ cell tumors: Treatment results and prognostic factors for survival and toxicity
Abstract: Purpose: The efficacy and toxicity of high-dose carboplatin, etoposide, and cyclophosphamide with autologous bone morrow transplantation (AuBMT) was investigated in a prospective trial for patients with cisplatin-refractory germ cell tumor (GCT). Prognostic factors for survival and treatment-related toxicity were identified. Patients and Methods: Fifty-eight patients with refractory GCT were treated with high-dose carboplatin, etoposide, and cyclophosphamide plus AuBMT. Prognostic factors for toxicity and survival were examined in multivariate analyses. Results: Twenty-three patients (40%) achieved a complete response and 12 (21%) are alive and free of disease at a median fallow-up time of 28 months. Myelosuppression was severe and there were seven (12%) treatment-related deaths. Independently predictive factors that resulted in faster blood count recovery were the use of granulocyte colony-stimulating factor (G-CSF) for the number of days to neutrophil count recovery (P = .013) and prior treatment with cisplatin limited to six cycles or less for the number of days to platelet count recovery (P = .0012). Both were predictive for the number of days of hospitalization (P = .04 and .03, respectively). The two independently predictive variables for survival were pretreatment level of HCG; human chorionic gonadotrophin (HCG; ≤ 100 times the upper limit of normal [xnl] v > 100 xnl, P = .02) and the presence of retroperitoneal metastases (yes or no, P = .04). Patients grouped by HCG ≤ 100 xnl with retroperitoneal metastases, HCG ≤ 100 xnl without retroperitoneal metastases, and all patients with HCG more than 100 xnl had median survival times of 14, 11, and 3 months, respectively (P = .04). Conclusion: High-dose carboplatin, etoposide, and cyclophosphamide is an effective therapy for patients with refractory GCT, and results in a complete response proportion of 40% and a 2-year survival rate of 31% at a median follow-up time of 28 months. This was accomplished in a group of patients with a dismal prognosis to conventional-dose therapy.
Keywords: adolescent; adult; cancer survival; treatment outcome; survival analysis; antibiotic agent; major clinical study; clinical trial; cancer recurrence; cisplatin; cancer combination chemotherapy; drug megadose; antineoplastic agent; prospective studies; carboplatin; metastasis; liver toxicity; nephrotoxicity; bone marrow suppression; etoposide; antineoplastic combined chemotherapy protocols; drug administration schedule; granulocyte macrophage colony stimulating factor; antineoplastic agents, phytogenic; cyclophosphamide; tumor marker; ifosfamide; vinblastine; gastrointestinal toxicity; cytokine; multicenter study; ovary tumor; antineoplastic agents, alkylating; testis tumor; bleomycin; retroperitoneal tumor; germ cell tumor; mediastinum tumor; granulocyte colony stimulating factor; intravenous drug administration; autologous bone marrow transplantation; germinoma; amphotericin b; subcutaneous drug administration; humans; prognosis; human; male; female; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 14
Issue: 4
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 1996-04-01
Start Page: 1098
End Page: 1105
Language: English
PUBMED: 8648363
PROVIDER: scopus
DOI: 10.1200/JCO.1996.14.4.1098
Notes: Article -- Export Date: 22 November 2017 -- Source: Scopus
Citation Impact
MSK Authors
  1. Dean Bajorin
    604 Bajorin
  2. Robert Motzer
    1084 Motzer
  3. Madhu Mazumdar
    127 Mazumdar
  4. George Bosl
    422 Bosl
  5. Vaia   Vlamis
    38 Vlamis