Review

. 2022 Jun:130 Suppl 1:5-16.

doi: 10.1111/bju.15648. Epub 2022 Mar 31.

High-dose chemotherapy for relapsed germ cell tumours: outcomes in low-volume specialized centres

Elizabeth A Connolly^{1

2}, Andrew Weickhardt^{3

4

5}, Peter Grimison^{1

2

5}, Rebecca Asher⁶, Gillian Z Heller^{2

6}, Jeremy Lewin^{7

5}, Elizabeth Liow^{7

8}, Guy Toner^{7

5}, Iris L Y Tung⁷, Ben Tran^{7

8

5}, Sean Hill⁹, Euan Walpole⁹, Jane McKenzie³, Anna Kuchel¹⁰, Jeffrey Goh¹⁰, Garry Forgeson¹¹, Alvin Tan¹², Abhishek Joshi¹³, Alistair Wickham¹⁴, Hsiang Tan¹⁵, Yang Wang¹⁶, Mark A Winstanley¹⁷, Nada Hamad^{18

19

20}, Vanessa Wong^{3

4}

Affiliations

¹ Chris O Brien Lifehouse, Sydney, Australia.
² University of Sydney, Sydney, Australia.
³ Olivia Newton-John Cancer and Wellness Centre Austin Health, Melbourne, Australia.
⁴ Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.
⁵ Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP).
⁶ NHMRC Clinical Trials Centre, Sydney, Sydney, Australia.
⁷ Peter MacCallum Cancer Centre, Melbourne, Australia.
⁸ Royal Melbourne Hospital, Melbourne, Australia.
⁹ Princess Alexandra Hospital, Brisbane, Australia.
¹⁰ Royal Brisbane and Women's Hospital and School of Medicine, University of Queensland, Brisbane, Australia.
¹¹ Palmerston North Hospital, Palmerston North, New Zealand.
¹² Waikato Hospital, Hamilton, New Zealand.
¹³ Townsville University Hospital, James Cook University, Townsville, Australia.
¹⁴ Auckland City Hospital, Auckland, New Zealand.
¹⁵ Royal Adelaide Hospital, Adelaide, Australia.
¹⁶ St Vincent's Hospital, Melbourne, Australia.
¹⁷ Starship Children's Hospital, Auckland, New Zealand.
¹⁸ Australasian Bone Marrow Transplant Recipient Registry (ABMTRR), Sydney, Australia.
¹⁹ St Vincent's Hospital Sydney, Sydney, Australia.
²⁰ University of New South Wales, Sydney, Australia.

PMID: 35355402
DOI: 10.1111/bju.15648

Review

High-dose chemotherapy for relapsed germ cell tumours: outcomes in low-volume specialized centres

Elizabeth A Connolly et al. BJU Int. 2022 Jun.

. 2022 Jun:130 Suppl 1:5-16.

doi: 10.1111/bju.15648. Epub 2022 Mar 31.

Authors

Affiliations

¹ Chris O Brien Lifehouse, Sydney, Australia.
² University of Sydney, Sydney, Australia.
³ Olivia Newton-John Cancer and Wellness Centre Austin Health, Melbourne, Australia.
⁴ Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.
⁵ Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP).
⁶ NHMRC Clinical Trials Centre, Sydney, Sydney, Australia.
⁷ Peter MacCallum Cancer Centre, Melbourne, Australia.
⁸ Royal Melbourne Hospital, Melbourne, Australia.
⁹ Princess Alexandra Hospital, Brisbane, Australia.
¹⁰ Royal Brisbane and Women's Hospital and School of Medicine, University of Queensland, Brisbane, Australia.
¹¹ Palmerston North Hospital, Palmerston North, New Zealand.
¹² Waikato Hospital, Hamilton, New Zealand.
¹³ Townsville University Hospital, James Cook University, Townsville, Australia.
¹⁴ Auckland City Hospital, Auckland, New Zealand.
¹⁵ Royal Adelaide Hospital, Adelaide, Australia.
¹⁶ St Vincent's Hospital, Melbourne, Australia.
¹⁷ Starship Children's Hospital, Auckland, New Zealand.
¹⁸ Australasian Bone Marrow Transplant Recipient Registry (ABMTRR), Sydney, Australia.
¹⁹ St Vincent's Hospital Sydney, Sydney, Australia.
²⁰ University of New South Wales, Sydney, Australia.

PMID: 35355402
DOI: 10.1111/bju.15648

Abstract

Objective: To report treatment patterns and survival outcomes of patients with relapsed and refractory metastatic germ cell tumours (GCTs) treated with high-dose chemotherapy (HDCT) and autologous stem-cell transplantation in low-volume specialized centres within the widely dispersed populations of Australia and New Zealand between 1999 and 2019.

Patients and methods: We conducted a retrospective analysis of 111 patients across 13 institutions. Patients were identified from the Australasian Bone Marrow Transplant Recipient Registry. We reviewed treatment regimens, survival outcomes, deliverability and toxicities. Primary endpoints included overall (OS) and progression-free survival (PFS). Cox proportional hazards models were used to test the association of survival outcomes with patient and treatment factors.

Results: The median (range) age was 30 (14-68) years and GCT histology was non-seminomatous in 84% of patients. International Prognostic Factors Study Group (IPFSG) prognostic risk category was very low/low, intermediate, high and very high in 18%, 36%, 25% and 21% of patients, respectively. Salvage conventional-dose chemotherapy (CDCT) was administered prior to HDCT in 59% of patients. Regimens included paclitaxel, ifosfamide, carboplatin and etoposide (50%), carboplatin and etoposide (CE; 28%), carboplatin, etoposide and ifosfamide (CEI; 6%), carboplatin, etoposide and cyclophosphamide (CEC; 5%), CEC-paclitaxel (6%) and other (5%). With a median follow-up of 4.4 years, the 1-, 2- and 5-year PFS rates were 62%, 57% and 52%, respectively, and OS rates were 73%, 65% and 61%, respectively. There were five treatment-related deaths. Progression on treatment occurred in 17%. In a univariable analysis, worse International Germ Cell Cancer Collaborative Group (IGCCCG) and IPFSG prognostic groups were associated with inferior survival outcomes. An association of inferior survival was not found with the number of high-dose cycles received nor when HDCT was delivered after salvage CDCT.

Conclusion: This large dual-national registry-based study reinforces the efficacy and deliverability of HDCT for relapsed and refractory metastatic GCT in low-volume specialized centres in Australia and New Zealand, with survival outcomes comparable to those found in international practice.

Keywords: salvage therapy; testicular cancer.

PubMed Disclaimer

Cited by

Targeted drug delivery using nanobodies to deliver effective molecules to breast cancer cells: the most attractive application of nanobodies.
Abdolvahab MH, Karimi P, Mohajeri N, Abedini M, Zare H. Abdolvahab MH, et al. Cancer Cell Int. 2024 Feb 10;24(1):67. doi: 10.1186/s12935-024-03259-8. Cancer Cell Int. 2024. PMID: 38341580 Free PMC article. Review.
Salvage Treatment for Extragonadal Germ Cell Tumours: High-Dose Chemotherapy and Autologous Stem Cell Transplantation Outcomes-A Single-Centre Experience.
Topal A, Erturk I, Koseoglu C, Dumludag A, Kuzu ÖF, Karadurmus B, Kaplan Tuzun E, Atacan H, Mammadzada N, Yildirim G, Acar R, Karadurmus N. Topal A, et al. J Clin Med. 2024 Oct 29;13(21):6494. doi: 10.3390/jcm13216494. J Clin Med. 2024. PMID: 39518633 Free PMC article.
Efficacy and Safety of Three Cycles of TIP and Sequential High Dose Chemotherapy in Patients with Testicular Non-Seminomatous Germ Cell Tumors.
Aykan MB, Yildiran Keskin G, Erturk İ, Acar R, Kose AF, Karadurmus N. Aykan MB, et al. J Clin Med. 2024 Dec 29;14(1):131. doi: 10.3390/jcm14010131. J Clin Med. 2024. PMID: 39797214 Free PMC article.

References

1. Hanna NH, Einhorn LH. Testicular cancer-discoveries and updates. N Engl J Med 2014; 371(21): 2005-16
1. Daugaard G. Management of poor-prognosis or relapsed germ-cell cancer. BJU Int 2009; 104(9 Pt B): 1392-7
1. National Comprehensive Cancer Network. Testicular Cancer, Version 1.2021. NCCN Clinical Practice Guidelines in Oncology. Accessed February 25, 2021. Available from: https://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf
1. Oldenburg J, Fosså SD, Nuver J et al. Testicular seminoma and non-seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24 Suppl 6: vi125-32
1. Petrelli F, Coinu A, Rosti G, Pedrazzoli P, Barni S. Salvage treatment for testicular cancer with standard- or high-dose chemotherapy: a systematic review of 59 studies. Med Oncol 2017; 34(8): 133

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
- Ovid Technologies, Inc.
- Wiley
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

High-dose chemotherapy for relapsed germ cell tumours: outcomes in low-volume specialized centres

Affiliations

High-dose chemotherapy for relapsed germ cell tumours: outcomes in low-volume specialized centres

Authors

Affiliations

Abstract

Similar articles

Cited by

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical

Abstract

Similar articles

Cited by

References

Publication types

MeSH terms

Substances

Related information

LinkOut - more resources

Full Text Sources

Medical