Salvage chemotherapy for patients with advanced pure seminoma Journal Article

Authors: Vuky, J.; Tickoo, S. K.; Sheinfeld, J.; Bacik, J.; Amsterdam, A.; Mazumdar, M.; Reuter, V.; Bajorin, D. F.; Bosl, G. J.; Motzer, R. J.
Article Title: Salvage chemotherapy for patients with advanced pure seminoma
Abstract: Purpose: We describe the response to conventional or high-dose salvage chemotherapy in patients with advanced seminoma who experience disease progression after receiving first-line platinum-based treatment. Patients and Methods: Twenty-seven patients with progressive, advanced, pure seminoma were treated with salvage chemotherapy. Fifteen patients were treated with conventional-dose cisplatin-and-ifosfamide combination chemotherapy. Twelve patients were treated with high-dose chemotherapy followed by autologous stem-cell rescue. Results: Fifteen patients (56%) achieved a complete response (CR), nine achieved CR with a conventional-dose cisplatin and ifosfamide program, and six experienced CR after high-dose chemotherapy. Fourteen patients (52%) are alive and disease-free, with 13 (48%) continuously disease-free at a median follow-up of 72 months. Twelve (57%) of 21 patients whose pretreatment tumors were studied morphologically were found to have seminoma with atypia. Eight patients underwent resection after salvage chemotherapy; six with histologic findings of necrotic debris/fibrosis alone are alive and disease-free at last follow-up. Both patients with viable seminoma found at surgery died of disease. Conclusion: Most patients with advanced seminoma are cured with standard first-line programs of cisplatin and etoposide with or without bleomycin. A small minority of patients with pure seminoma have resistant tumors and require salvage chemotherapy. In this setting, approximately 50% of patients with recurrent pure seminoma achieve durable CR with conventional or high-dose salvage chemotherapy. Identification of biologic markers to predict clinical outcome and an enhanced understanding of the basic biologic features of seminoma may lead to improvements in the management of this disease. © 2001 by American Society of Clinical Oncology.
Keywords: adult; cancer chemotherapy; clinical article; disease-free survival; middle aged; cancer surgery; survival rate; histopathology; salvage therapy; cisplatin; advanced cancer; paclitaxel; combined modality therapy; drug megadose; recurrent cancer; follow up; etoposide; antineoplastic combined chemotherapy protocols; stem cell transplantation; hematopoietic stem cell transplantation; ifosfamide; vinblastine; fibrosis; drug response; bleomycin; analysis of variance; seminoma; tumor necrosis; humans; human; male; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 20
Issue: 1
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2002-01-01
Start Page: 297
End Page: 301
Language: English
DOI: 10.1200/jco.20.1.297
PUBMED: 11773182
PROVIDER: scopus
Notes: Export Date: 14 November 2014 -- Source: Scopus
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MSK Authors
  1. Dean Bajorin
    404 Bajorin
  2. Robert Motzer
    745 Motzer
  3. Madhu Mazumdar
    120 Mazumdar
  4. Jacqueline Vuky
    7 Vuky
  5. Satish K Tickoo
    369 Tickoo
  6. Joel Sheinfeld
    195 Sheinfeld
  7. Victor Reuter
    900 Reuter
  8. George Bosl
    255 Bosl
  9. Jennifer M Bacik
    46 Bacik