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High-dose chemotherapy for relapsed testicular germ cell tumours

Abstract

Relapsed testicular germ cell tumours (GCTs) might be cured with salvage chemotherapy. Accepted salvage treatment is conventional-dose chemotherapy (CDCT) or high-dose chemotherapy (HDCT). HDCT with peripheral blood stem cell transplant might produce a higher number of durable responses than CDCT. We discuss studies reporting on outcomes of salvage HDCT in relapsed GCTs. The most reproducible results were achieved with HDCT with two cycles of etoposide and carboplatin or three cycles of the paclitaxel, ifosfamide, carboplatin and etoposide regime. Using these two regimens, sustained cure rates of 50–66% were reported in phase I, phase II and retrospective studies published in the past two decades. Cure rates in patients with cisplatin-resistant disease are between 30% and 45%. Two phase III randomized studies were conducted with certain limitations and were unsuccessful in showing a survival benefit of HDCT. Thus, salvage treatment remains a controversial topic. Salvage HDCT with peripheral blood stem cell transplant and CDCT are two recommended treatment options for relapsed GCTs. Consistently reported cure rates from phase I, phase II and large retrospective studies support the use of HDCT in the hands of an experienced team of oncologists.

Key points

  • Established salvage treatment for relapsed testicular germ cell tumours is conventional-dose chemotherapy or high-dose chemotherapy (HDCT), which might cure 20–60% of patients.

  • Consistently reported cure rates from phase I and II studies and large retrospective cohorts suggest that HDCT with two cycles of etoposide and carboplatin or three cycles of paclitaxel, ifosfamide, carboplatin and etoposide might be superior to conventional-dose chemotherapy.

  • HDCT with peripheral blood stem cell transplant is a standard approach in several high-volume institutions.

  • HDCT with peripheral blood stem cell transplant should be performed by teams of experienced oncologists.

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Fig. 1: Milestones in HDCT for relapsed GCTs.

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Acknowledgements

M.C. acknowledges funding from the Slovak Research and Development Agency under contract nos. APVV-15-0086, APVV-19-0411 and VEGA 1/0327/19.

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M.C. and N.A. researched data for the article, made a substantial contribution to discussion of the content, wrote and reviewed/edited the manuscript before submission. M.A.Z., R.A. and L.E. made a substantial contribution to discussion of the content, wrote and reviewed/edited the manuscript before submission.

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Correspondence to Michal Chovanec.

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Chovanec, M., Adra, N., Abu Zaid, M. et al. High-dose chemotherapy for relapsed testicular germ cell tumours. Nat Rev Urol (2022). https://doi.org/10.1038/s41585-022-00683-1

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