Review Article | Published:

Role of one, two and three doses of high-dose chemotherapy with autologous transplantation in the treatment of high-risk or relapsed testicular cancer: a systematic review

Bone Marrow Transplantationvolume 53pages12421254 (2018) | Download Citation

Abstract

Approximately 20–30% of patients with metastatic germ cell cancers (GCCs) can develop relapsed or refractory (RR) disease, about 40–50% of patients who relapse after salvage chemotherapy may reach long-term remission. The goal of this review was to identify patients who appear to benefit from high-dose chemotherapy (HDCT) and autologous stem cell transplant (ASCT). To access this, we performed a systematic medical literature review to evaluate the effectiveness of HDCT in the frontline setting, as well as in patients with RR testicular cancer. We searched databases for interventional clinical studies and identified 5883 studies. We selected 49 studies for inclusion, which included a total of 5985 patients. Seventeen studies reported results of newly diagnosed poor-risk GCC patients and 32 studies reported results of RR patients. For newly diagnosed patients with poor prognostic predictors, a risk adjusted strategy using unfavorable tumor marker decline with initial standard chemotherapy regimen and upfront HDCT demonstrated improved outcomes. Our data suggest a minimum of two HDCT cycles with ASCT should be standard of care for patients with RR GCC. Failure of HDCT results in a poor prognosis with only 10% of patients achieving lasting remission with salvage therapy.

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Acknowledgements

This work was supported in part by grant P30 CA023074 from the National Cancer Institute, National Institutes of Health, Bethesda, MD.

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Affiliations

  1. Department of Hematology and Oncology, Mayo Clinic, Rochester, MN, 55905, USA

    • Irbaz bin Riaz
  2. Department of Medicine, Bronx Lebanon Hospital, Mount Sinai School of Medicine, Bronx, NY, 104576, USA

    • Muhammad Umar
  3. Department of Biostatics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, 85721, USA

    • Umar Zahid
  4. Division of Hematology Oncology, Department of Medicine, University of Miami, Miami, FL, 33146, USA

    • Muhammad Husnain
  5. Division of Hematology Oncology, Department of Medicine, University of Arizona, Tucson, AZ, 85724, USA

    • Ahmad Iftikhar
    • , Farva Razia Gondal
    • , Frederick Ahman
    •  & Faiz Anwer
  6. College of Pharmacy, University of Arizona, Tucson, AZ, 85721, USA

    • Ali McBride
  7. Department of Medicine, University of Arizona, Tucson, AZ, 85721, USA

    • Jawad Bilal
    • , Zeeshan Ali
    •  & Qurat Ul Ain Riaz Sipra
  8. Medical College, Aga Khan University, Sindh, Karachi, 74800, Pakistan

    • Asad Javed
    •  & Sara Akbar
  9. Department of Hematology Oncology, Mayo Clinic, Scottsdale, AZ, 85259, USA

    • Parminder Singh

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The authors declare that they have no conflict of interest.

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Correspondence to Faiz Anwer.

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https://doi.org/10.1038/s41409-018-0188-3