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 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 22 November 2017 -- Source: Scopus |
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