TI-CE high-dose chemotherapy for patients with previously treated germ cell tumors: Results and prognostic factor analysis Journal Article


Authors: Feldman, D. R.; Sheinfeld, J.; Bajorin, D. F.; Fischer, P.; Turkula, S.; Ishill, N.; Patil, S.; Bains, M.; Reich, L. M.; Bosl, G. J.; Motzer, R. J.
Article Title: TI-CE high-dose chemotherapy for patients with previously treated germ cell tumors: Results and prognostic factor analysis
Abstract: Purpose We previously reported a dose-finding and phase II trial of the TI-CE regimen (paclitaxel [T] plus ifosfamide [I] followed by high-dose carboplatin [C] plus etoposide [E] with stem-cell support) in germ cell tumor (GCT) patients predicted to have a poor prognosis with conventional-dose salvage therapy. We now report the efficacy of TI-CE with prognostic factors for disease-free survival (DFS) and overall survival (OS) in our full data set of 107 patients. Patients and Methods Eligible patients had advanced GCTs with progressive disease following chemotherapy and unfavorable prognostic features (extragonadal primary site, incomplete response [IR] to first-line therapy, or relapse/IR to ifosfamide-cisplatin-based conventional-dose salvage). Univariate and multivariate analyses (MVAs) of prognostic factors were performed. The predictive ability of the Einhorn and Beyer prognostic models was assessed. Results Most patients were platinum refractory and had an IR to first-line chemotherapy. There were 54 (50%) complete and eight (8%) partial responses with negative markers; 5-year DFS was 47% and OS was 52% (median follow-up, 61 months). No relapses occurred after 2 years. Five (24%) of 21 primary mediastinal nonseminomatous GCTs are continuously disease free. On MVA, primary mediastinal site (P < .001), two or more lines of prior therapy (P < .001), baseline human chorionic gonadotropin >= 1,000 U/ L (P = .01), and lung metastases (P = .02) significantly predicted adverse DFS. Poor-risk patients did worse than good-or intermediate-risk patients according to both Beyer (P < .002) and Einhorn (P < .05) models. Conclusion TI-CE is effective salvage therapy for GCT patients with poor prognostic features. Mediastinal primary site and two or more lines of prior therapy were most predictive of adverse DFS. Beyer and Einhorn models can assist in predicting outcome. J Clin Oncol 28: 1706-1713. (C) 2010 by American Society of Clinical Oncology
Keywords: salvage therapy; cisplatin; paclitaxel; carboplatin; etoposide; transplantation; ifosfamide; center experience; rescue
Journal Title: Journal of Clinical Oncology
Volume: 28
Issue: 10
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2010-04-01
Start Page: 1706
End Page: 1713
Language: English
ACCESSION: ISI:000276152200016
DOI: 10.1200/jco.2009.25.1561
PROVIDER: wos
PUBMED: 20194867
PMCID: PMC3651604
Notes: --- - Article - "Source: Wos"
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MSK Authors
  1. Sujata Patil
    383 Patil
  2. Dean Bajorin
    404 Bajorin
  3. Robert Motzer
    745 Motzer
  4. Darren Richard Feldman
    171 Feldman
  5. Joel Sheinfeld
    195 Sheinfeld
  6. Patricia Marie Russ Fischer
    19 Fischer
  7. Lilian M Reich
    70 Reich
  8. Manjit S Bains
    227 Bains
  9. George Bosl
    255 Bosl
  10. Nicole Marie Leoce
    86 Leoce