Early salvage therapy for germ cell cancer using high dose chemotherapy with autologous bone marrow support

E. R. Broun, C. R. Nichols, M. Turns, S. D. Williams, Patrick Loehrer, B. J. Roth, H. M. Lazarus, Lawrence Einhorn

Research output: Contribution to journalArticle

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Abstract

Background. Patients with relapsed germ cell cancer (GCT) have a poor prognosis when treated solely with conventional chemotherapy; high dose chemotherapy with autologous bone marrow rescue (ABMR) has shown curative potential in patients with relapsed and refractory GCT. This protocol was designed to incorporate high dose therapy with initial salvage therapy. Methods. Twenty-three patients in the first relapse of GCT received two cycles of conventional dose cisplatin-based therapy (either vinblastine, ifosfamide and cisplatin [VeIP] or cisplatin, vinblastine, and bleomycin) followed by carboplatin (1500-2100 mg/m2) and etoposide (1200-2250 mg/m2) given in divided doses with ABMR. Results. Eighteen of 23 patients completed protocol therapy including high dose therapy. Five of 23 did not undergo high dose therapy due to: insurance refusal (1); patient refusal (1); active infection (1); central nervous system metastasis (1); death on induction therapy (1). Response to two courses of conventional dose induction therapy (N = 23) was complete response (CR), 8; partial response (PR), 12; stable disease (SD), 2; and toxic death, 1. Two of five individuals who did not continue with high dose therapy are alive and progression free after conventional salvage therapy and surgery with at least 24 months of follow- up. Outcome after high dose therapy (N = 18) was CR, 9, PR, 6, SD, 1, and PD, 2. Two patients who were in PR after receiving two cycles of conventional dose therapy were converted to CR using high dose therapy. There was only one treatment-related death in this cohort, a septic death during VeIP induction therapy. There were no transplant related deaths. Of those patients completing high dose therapy, 7 of 18 (39%) survived, progression free with a median follow-up of 26 months, 2 of 18 are alive with active disease, and 9 of 18 died of recurrent disease. Conclusions. Conventional dose induction therapy followed by consolidation with high dose therapy and ABMR is well tolerated and provides prolonged disease-free survival in some patients with chemosensitive relapsed germ cell cancer.

Original languageEnglish
Pages (from-to)1716-1720
Number of pages5
JournalCancer
Volume73
Issue number6
StatePublished - 1994

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Salvage Therapy
Germ Cell and Embryonal Neoplasms
Secondary Prevention
Bone Marrow
Drug Therapy
Therapeutics
Cisplatin
Vinblastine
Ifosfamide
Poisons
Carboplatin
Bleomycin
Etoposide

Keywords

  • bone marrow transplantation
  • carboplatin
  • etoposide
  • germ cell neoplasms

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Broun, E. R., Nichols, C. R., Turns, M., Williams, S. D., Loehrer, P., Roth, B. J., ... Einhorn, L. (1994). Early salvage therapy for germ cell cancer using high dose chemotherapy with autologous bone marrow support. Cancer, 73(6), 1716-1720.

Early salvage therapy for germ cell cancer using high dose chemotherapy with autologous bone marrow support. / Broun, E. R.; Nichols, C. R.; Turns, M.; Williams, S. D.; Loehrer, Patrick; Roth, B. J.; Lazarus, H. M.; Einhorn, Lawrence.

In: Cancer, Vol. 73, No. 6, 1994, p. 1716-1720.

Research output: Contribution to journalArticle

Broun, ER, Nichols, CR, Turns, M, Williams, SD, Loehrer, P, Roth, BJ, Lazarus, HM & Einhorn, L 1994, 'Early salvage therapy for germ cell cancer using high dose chemotherapy with autologous bone marrow support', Cancer, vol. 73, no. 6, pp. 1716-1720.
Broun ER, Nichols CR, Turns M, Williams SD, Loehrer P, Roth BJ et al. Early salvage therapy for germ cell cancer using high dose chemotherapy with autologous bone marrow support. Cancer. 1994;73(6):1716-1720.
Broun, E. R. ; Nichols, C. R. ; Turns, M. ; Williams, S. D. ; Loehrer, Patrick ; Roth, B. J. ; Lazarus, H. M. ; Einhorn, Lawrence. / Early salvage therapy for germ cell cancer using high dose chemotherapy with autologous bone marrow support. In: Cancer. 1994 ; Vol. 73, No. 6. pp. 1716-1720.
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abstract = "Background. Patients with relapsed germ cell cancer (GCT) have a poor prognosis when treated solely with conventional chemotherapy; high dose chemotherapy with autologous bone marrow rescue (ABMR) has shown curative potential in patients with relapsed and refractory GCT. This protocol was designed to incorporate high dose therapy with initial salvage therapy. Methods. Twenty-three patients in the first relapse of GCT received two cycles of conventional dose cisplatin-based therapy (either vinblastine, ifosfamide and cisplatin [VeIP] or cisplatin, vinblastine, and bleomycin) followed by carboplatin (1500-2100 mg/m2) and etoposide (1200-2250 mg/m2) given in divided doses with ABMR. Results. Eighteen of 23 patients completed protocol therapy including high dose therapy. Five of 23 did not undergo high dose therapy due to: insurance refusal (1); patient refusal (1); active infection (1); central nervous system metastasis (1); death on induction therapy (1). Response to two courses of conventional dose induction therapy (N = 23) was complete response (CR), 8; partial response (PR), 12; stable disease (SD), 2; and toxic death, 1. Two of five individuals who did not continue with high dose therapy are alive and progression free after conventional salvage therapy and surgery with at least 24 months of follow- up. Outcome after high dose therapy (N = 18) was CR, 9, PR, 6, SD, 1, and PD, 2. Two patients who were in PR after receiving two cycles of conventional dose therapy were converted to CR using high dose therapy. There was only one treatment-related death in this cohort, a septic death during VeIP induction therapy. There were no transplant related deaths. Of those patients completing high dose therapy, 7 of 18 (39{\%}) survived, progression free with a median follow-up of 26 months, 2 of 18 are alive with active disease, and 9 of 18 died of recurrent disease. Conclusions. Conventional dose induction therapy followed by consolidation with high dose therapy and ABMR is well tolerated and provides prolonged disease-free survival in some patients with chemosensitive relapsed germ cell cancer.",
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T1 - Early salvage therapy for germ cell cancer using high dose chemotherapy with autologous bone marrow support

AU - Broun, E. R.

AU - Nichols, C. R.

AU - Turns, M.

AU - Williams, S. D.

AU - Loehrer, Patrick

AU - Roth, B. J.

AU - Lazarus, H. M.

AU - Einhorn, Lawrence

PY - 1994

Y1 - 1994

N2 - Background. Patients with relapsed germ cell cancer (GCT) have a poor prognosis when treated solely with conventional chemotherapy; high dose chemotherapy with autologous bone marrow rescue (ABMR) has shown curative potential in patients with relapsed and refractory GCT. This protocol was designed to incorporate high dose therapy with initial salvage therapy. Methods. Twenty-three patients in the first relapse of GCT received two cycles of conventional dose cisplatin-based therapy (either vinblastine, ifosfamide and cisplatin [VeIP] or cisplatin, vinblastine, and bleomycin) followed by carboplatin (1500-2100 mg/m2) and etoposide (1200-2250 mg/m2) given in divided doses with ABMR. Results. Eighteen of 23 patients completed protocol therapy including high dose therapy. Five of 23 did not undergo high dose therapy due to: insurance refusal (1); patient refusal (1); active infection (1); central nervous system metastasis (1); death on induction therapy (1). Response to two courses of conventional dose induction therapy (N = 23) was complete response (CR), 8; partial response (PR), 12; stable disease (SD), 2; and toxic death, 1. Two of five individuals who did not continue with high dose therapy are alive and progression free after conventional salvage therapy and surgery with at least 24 months of follow- up. Outcome after high dose therapy (N = 18) was CR, 9, PR, 6, SD, 1, and PD, 2. Two patients who were in PR after receiving two cycles of conventional dose therapy were converted to CR using high dose therapy. There was only one treatment-related death in this cohort, a septic death during VeIP induction therapy. There were no transplant related deaths. Of those patients completing high dose therapy, 7 of 18 (39%) survived, progression free with a median follow-up of 26 months, 2 of 18 are alive with active disease, and 9 of 18 died of recurrent disease. Conclusions. Conventional dose induction therapy followed by consolidation with high dose therapy and ABMR is well tolerated and provides prolonged disease-free survival in some patients with chemosensitive relapsed germ cell cancer.

AB - Background. Patients with relapsed germ cell cancer (GCT) have a poor prognosis when treated solely with conventional chemotherapy; high dose chemotherapy with autologous bone marrow rescue (ABMR) has shown curative potential in patients with relapsed and refractory GCT. This protocol was designed to incorporate high dose therapy with initial salvage therapy. Methods. Twenty-three patients in the first relapse of GCT received two cycles of conventional dose cisplatin-based therapy (either vinblastine, ifosfamide and cisplatin [VeIP] or cisplatin, vinblastine, and bleomycin) followed by carboplatin (1500-2100 mg/m2) and etoposide (1200-2250 mg/m2) given in divided doses with ABMR. Results. Eighteen of 23 patients completed protocol therapy including high dose therapy. Five of 23 did not undergo high dose therapy due to: insurance refusal (1); patient refusal (1); active infection (1); central nervous system metastasis (1); death on induction therapy (1). Response to two courses of conventional dose induction therapy (N = 23) was complete response (CR), 8; partial response (PR), 12; stable disease (SD), 2; and toxic death, 1. Two of five individuals who did not continue with high dose therapy are alive and progression free after conventional salvage therapy and surgery with at least 24 months of follow- up. Outcome after high dose therapy (N = 18) was CR, 9, PR, 6, SD, 1, and PD, 2. Two patients who were in PR after receiving two cycles of conventional dose therapy were converted to CR using high dose therapy. There was only one treatment-related death in this cohort, a septic death during VeIP induction therapy. There were no transplant related deaths. Of those patients completing high dose therapy, 7 of 18 (39%) survived, progression free with a median follow-up of 26 months, 2 of 18 are alive with active disease, and 9 of 18 died of recurrent disease. Conclusions. Conventional dose induction therapy followed by consolidation with high dose therapy and ABMR is well tolerated and provides prolonged disease-free survival in some patients with chemosensitive relapsed germ cell cancer.

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KW - carboplatin

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