Paclitaxel plus ifosfamide followed by high-dose carboplatin plus etoposide in previously treated germ cell tumors Journal Article

Authors: Kondagunta, G. V.; Bacik, J.; Sheinfeld, J.; Bajorin, D.; Bains, M.; Reich, L.; Deluca, J.; Budnick, A.; Ishill, N.; Mazumdar, M.; Bosl, G. J.; Motzer, R. J.
Article Title: Paclitaxel plus ifosfamide followed by high-dose carboplatin plus etoposide in previously treated germ cell tumors
Abstract: Purpose: To evaluate the optimal dose of carboplatin as well as the efficacy and tolerability of sequential, dose-intense chemotherapy with paclitaxel and ifosfamide followed by carboplatin and etoposide (TICE) plus peripheral-blood stem-cell (PBSC) support in patients with germ cell tumors (GCT) who are likely to experience treatment failure with conventional-dose salvage treatment. This prospective trial followed a similarly designed report of TICE, which used a different means of carboplatin dosing. Patients and Methods: The 48 patients entered onto this trial had progressive GCT and unfavorable prognostic features after chemotherapy. Two cycles of paclitaxel plus ifosfamide were administered with leukapheresis, followed by three cycles of carboplatin plus etoposide with reinfusion of PBSC. Results: Twenty-three (49%) of 47 assessable patients achieved a complete response (CR) to chemotherapy. An additional three patients (6%) achieved a CR to chemotherapy and surgery. The CR rate was 55%. Six patients experienced relapse, but 24 patients (51%) are alive and free of disease at a median follow-up time of 40 months. Four patients who experienced relapse or achieved an incomplete response were rendered disease free by salvage surgical resection. When combined with results of the prior trial of similar design, TICE chemotherapy yielded an overall CR of 56% (n = 84), with 50% of patients alive with no evidence of disease. Conclusion: TICE is an effective and tolerable dose-intense treatment for patients with previously treated metastatic GCT who have a poor predicted outcome to conventional-dose salvage chemotherapy. © 2007 by American Society of Clinical Oncology.
Keywords: adolescent; adult; cancer survival; clinical article; controlled study; treatment outcome; treatment response; disease-free survival; middle aged; cancer surgery; human cell; clinical trial; drug tolerability; salvage therapy; cancer combination chemotherapy; diarrhea; drug efficacy; paclitaxel; disease free survival; drug megadose; follow up; antineoplastic agent; anorexia; neoplasm; carboplatin; metastasis; controlled clinical trial; multiple cycle treatment; phase 2 clinical trial; bone marrow suppression; etoposide; neuropathy; antineoplastic combined chemotherapy protocols; stem cell transplantation; ifosfamide; drug dose escalation; febrile neutropenia; neoplasm metastasis; cancer relapse; colitis; neoplasms, germ cell and embryonal; phase 1 clinical trial; mesna; drug dose increase; peripheral blood stem cell transplantation; germ cell tumor; hearing disorder; electrolyte disturbance; leukapheresis
Journal Title: Journal of Clinical Oncology
Volume: 25
Issue: 1
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2007-01-01
Start Page: 85
End Page: 90
Language: English
DOI: 10.1200/jco.2006.06.9401
PUBMED: 17194908
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 32" - "Export Date: 17 November 2011" - "CODEN: JCOND" - "Source: Scopus"
Citation Impact
MSK Authors
  1. Dean Bajorin
    601 Bajorin
  2. Robert Motzer
    1075 Motzer
  3. Madhu Mazumdar
    127 Mazumdar
  4. Joel Sheinfeld
    241 Sheinfeld
  5. Amy S Budnick
    18 Budnick
  6. Lilian M Reich
    96 Reich
  7. Manjit S Bains
    300 Bains
  8. George Bosl
    417 Bosl
  9. Nicole Marie Leoce
    86 Leoce
  10. John Vito K Deluca
    8 Deluca
  11. Jennifer M Bacik
    46 Bacik