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Lookup NU author(s): Dr Christoph OingORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2024 The Author(s)Background: In relapsed or refractory (RR) metastatic germ cell cancer (GCC), high-dose (HD) chemotherapy (CTX) plus autologous stem cell transplantation is considered the standard of care. Limited data exist regarding the efficacy of HD-CTX following conventionally dosed salvage regimens (CDRs). This analysis explores and contrasts the efficacy of HD-CTX as the first or subsequent salvage regimen. Patients and methods: Data were retrospectively collected to explore the efficacy of HD-CTX administered as the first (group A) or subsequent salvage CTX (group B) after a CDR. The primary endpoint was OS from the time of HD-CTX. Associations of survival, overall response rate (ORR), and toxicity with clinical characteristics were explored using stratified Kaplan–Meier and Cox regression models. Results: Overall, 283 patients with GCC were included from 11 international centers, with 159 patients (56%) in group A and 124 patients (44%) in group B. The first salvage treatment was administered between 1998 and 2022, with a median follow-up of 27.0 [standard deviation (SD) 46.2] months for group A and 17.0 (SD 48.5) months for group B. The median OS from HD-CTX treatment initiation was not reached in group A, compared with 25 months in group B (P = 0.00027), associated with 2- and 5-year OS rates of 74% and 63% (group A) versus 53% and 37% (group B), respectively. When administered as the first salvage treatment, HD-CTX was associated with a higher ORR (79% versus 60%; P = 0.013) and lower nonhematologic grade ≥3 toxicity rate (78% versus 97%; P < 0.001). Concerning risk factor analysis for the total cohort, the International Prognostic Factors Study Group score was the only independent predictor of OS in multivariable analysis (P = 0.006). Conclusions: When administered as the initial salvage treatment or after CDR, HD-CTX exhibits curative potential for patients with RR GCC. The efficacy and safety outcomes were more favorable when HD-CTX was conducted as the first salvage treatment line.
Author(s): Seidel C, Schaefers C, Connolly EA, Weickhardt A, Grimison P, Wong V, De Giorgi U, Hentrich M, Zschabitz S, Ochsenreither S, Vincenzi B, Oing C, Bokemeyer C, Engel N, Alsdorf W, Tran B
Publication type: Article
Publication status: Published
Journal: ESMO Open
Year: 2024
Volume: 9
Issue: 5
Print publication date: 01/05/2024
Online publication date: 13/05/2024
Acceptance date: 02/04/2018
Date deposited: 24/07/2024
ISSN (electronic): 2059-7029
Publisher: Elsevier B.V.
URL: https://doi.org/10.1016/j.esmoop.2024.103449
DOI: 10.1016/j.esmoop.2024.103449
PubMed id: 38744098
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