Incidence of late-relapse germ cell tumor and outcome to salvage chemotherapy Journal Article


Authors: Ronnen, E. A.; Kondagunta, G. V.; Bacik, J.; Marion, S.; Bajorin, D. F.; Sheinfeld, J.; Bosl, G. J.; Motzer, R. J.
Article Title: Incidence of late-relapse germ cell tumor and outcome to salvage chemotherapy
Abstract: Purpose: To define the incidence, clinical features, and outcome to salvage chemotherapy in patients with late-relapse germ cell tumor (GCT) after a complete response to first-line chemotherapy. Patients and Methods: Two patient populations were examined. First, retrospective analysis of 246 patients treated on a clinical trial with salvage chemotherapy was performed; 29 patients with late-relapse GCT were identified and evaluated for treatment outcome and survival. Salvage regimens included paclitaxel, ifosfamide, and cisplatin, single agents, or a high-dose chemotherapy program. Second, the incidence of late relapse was assessed by retrospective analysis of 551 patients after a complete response (CR) to first-line chemotherapy. Results: Twenty-nine patients received salvage chemotherapy on a clinical trial for late relapse GCT. The median survival was 23.9 months. At a median follow-up of 50.6 months, there were nine survivors. The chemotherapy regimens varied, but the only CRs were observed in patients treated with paclitaxel, ifosfamide, and cisplatin. Seven (50%) of 14 patients treated with paclitaxel, ifosfamide, and cisplatin achieved a continuous CR. Among the second population of 551 patients who had previously achieved a CR to a first-line chemotherapy trial, 17 were identified as having a late relapse (3%). The median time to relapse for these 17 patients was 7.8 years. Conclusion: Late-relapse GCT is uncommon and is associated with a poor prognosis resulting from a high degree of resistance to chemotherapy. Chemotherapy with paclitaxel, ifosfamide, and cisplatin followed by surgery may be effective in patients with late-relapse GCT who are not considered candidates for primary surgery. © 2005 by American Society of Clinical Oncology.
Keywords: survival; adult; cancer survival; clinical article; controlled study; treatment outcome; treatment response; survival analysis; retrospective studies; clinical feature; clinical trial; salvage therapy; cisplatin; cancer combination chemotherapy; bone metastasis; paclitaxel; drug megadose; antineoplastic agent; cancer incidence; lymph node dissection; carboplatin; controlled clinical trial; neoplasm recurrence, local; etoposide; antineoplastic combined chemotherapy protocols; incidence; cyclophosphamide; pathology; retrospective study; ifosfamide; liver metastasis; lung metastasis; tumor recurrence; brain metastasis; testis tumor; testicular neoplasms; cancer relapse; orchiectomy; mesna; germ cell tumor; retroperitoneal cancer; mediastinum metastasis; germinoma
Journal Title: Journal of Clinical Oncology
Volume: 23
Issue: 28
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2005-10-01
Start Page: 6999
End Page: 7004
Language: English
DOI: 10.1200/jco.2005.21.956
PUBMED: 16192587
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 37" - "Export Date: 24 October 2012" - "CODEN: JCOND" - "Source: Scopus"
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MSK Authors
  1. Ellen Arielle Ronnen
    11 Ronnen
  2. Dean Bajorin
    416 Bajorin
  3. Robert Motzer
    769 Motzer
  4. Joel Sheinfeld
    197 Sheinfeld
  5. George Bosl
    270 Bosl
  6. Jennifer M Bacik
    46 Bacik
  7. Stephanie Marion
    8 Marion