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Connolly EA, Weickhardt A, Grimison P, Asher R, Heller GZ, Lewin J, Liow E, Toner G, Tung ILY, Tran B, Hill S, Walpole E, McKenzie J, Kuchel A, Goh J, Forgeson G, Tan A, Joshi A, Wickham A, Tan H, Wang Y, Winstanley MA, Hamad N, Wong V. High-dose chemotherapy for relapsed germ cell tumours: outcomes in low-volume specialized centres. BJU Int 2022; 130 Suppl 1:5-16. [PMID: 35355402 DOI: 10.1111/bju.15648] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022]
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.
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Affiliation(s)
- Elizabeth A Connolly
- Chris O Brien Lifehouse, Sydney, Australia.,University of Sydney, Sydney, Australia
| | - Andrew Weickhardt
- Olivia Newton-John Cancer and Wellness Centre Austin Health, Melbourne, Australia.,Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.,Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP)
| | - Peter Grimison
- Chris O Brien Lifehouse, Sydney, Australia.,University of Sydney, Sydney, Australia.,Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP)
| | - Rebecca Asher
- NHMRC Clinical Trials Centre, Sydney, Sydney, Australia
| | - Gillian Z Heller
- University of Sydney, Sydney, Australia.,NHMRC Clinical Trials Centre, Sydney, Sydney, Australia
| | - Jeremy Lewin
- Peter MacCallum Cancer Centre, Melbourne, Australia.,Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP)
| | - Elizabeth Liow
- Peter MacCallum Cancer Centre, Melbourne, Australia.,Royal Melbourne Hospital, Melbourne, Australia
| | - Guy Toner
- Peter MacCallum Cancer Centre, Melbourne, Australia.,Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP)
| | | | - Ben Tran
- Peter MacCallum Cancer Centre, Melbourne, Australia.,Royal Melbourne Hospital, Melbourne, Australia.,Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP)
| | - Sean Hill
- Princess Alexandra Hospital, Brisbane, Australia
| | - Euan Walpole
- Princess Alexandra Hospital, Brisbane, Australia
| | - Jane McKenzie
- Olivia Newton-John Cancer and Wellness Centre Austin Health, Melbourne, Australia
| | - Anna Kuchel
- Royal Brisbane and Women's Hospital and School of Medicine, University of Queensland, Brisbane, Australia
| | - Jeffrey Goh
- Royal Brisbane and Women's Hospital and School of Medicine, University of Queensland, Brisbane, Australia
| | - Garry Forgeson
- Palmerston North Hospital, Palmerston North, New Zealand
| | - Alvin Tan
- Waikato Hospital, Hamilton, New Zealand
| | - Abhishek Joshi
- Townsville University Hospital, James Cook University, Townsville, Australia
| | | | - Hsiang Tan
- Royal Adelaide Hospital, Adelaide, Australia
| | - Yang Wang
- St Vincent's Hospital, Melbourne, Australia
| | | | - Nada Hamad
- Australasian Bone Marrow Transplant Recipient Registry (ABMTRR), Sydney, Australia.,St Vincent's Hospital Sydney, Sydney, Australia.,University of New South Wales, Sydney, Australia
| | - Vanessa Wong
- Olivia Newton-John Cancer and Wellness Centre Austin Health, Melbourne, Australia.,Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
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Sokolova A, Chan O, Ullah W, Hamdani AA, Anwer F. Delayed rhabdomyolysis with paclitaxel, ifosfamide, carboplatin, and etoposide regimen: a case report. J Med Case Rep 2017; 11:100. [PMID: 28395668 PMCID: PMC5387351 DOI: 10.1186/s13256-017-1272-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/21/2017] [Indexed: 11/21/2022] Open
Abstract
Background High-dose chemotherapy with autologous stem cell rescue is commonly used for the treatment of relapsed germ cell tumors. We report the first case of delayed rhabdomyolysis with paclitaxel, ifosfamide, carboplatin, and etoposide regimen. Case presentation We report a case of a 21-year-old African-American man diagnosed with relapsed non-seminomatous germ cell tumor who received high-dose chemotherapy with carboplatin and etoposide following TIGER trial arm B off-protocol. His course was complicated by muscle pain and rhabdomyolysis after cycle 4 on day +12 after infusion of autologous stem cells. To the best of our knowledge, this complication has not been reported with this regimen. A differential diagnosis of sepsis and neutropenic fever along with side effects of high-dose chemotherapy were considered, but based on the timing of events, it was concluded that the etiology of rhabdomyolysis is high-dose chemotherapy. Rhabdomyolysis was successfully treated with hydration and did not recur during subsequent cycle 5. Conclusions Delayed rhabdomyolysis after high-dose chemotherapy with paclitaxel, ifosfamide, carboplatin, and etoposide regimen has not been previously reported and needs to be considered for preventive strategy and prompt diagnosis and treatment to avoid renal complications. Physicians should have a low threshold to check creatine kinase enzymes in patients with unexplained muscle pain or renal insufficiency after high-dose chemotherapy.
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Affiliation(s)
- Alexandra Sokolova
- Department of Medicine, Nassau University Medical Cite Center, 2201 Hempstead Turnpike, East Meadow, NY, 11554, USA
| | - Onyee Chan
- Department of Medicine, University of Arizona, Banner University Medical Center - Tucson, 1501 N. Campbell Ave., Tucson, AZ, 85724, USA.
| | - Waqas Ullah
- Department of Medicine, University of Arizona, Banner University Medical Center - Tucson, 1501 N. Campbell Ave., Tucson, AZ, 85724, USA
| | - Auon Abbas Hamdani
- Department of Medicine, University of Arizona, Banner University Medical Center - Tucson, 1501 N. Campbell Ave., Tucson, AZ, 85724, USA
| | - Faiz Anwer
- Department of Medicine, University of Arizona, Banner University Medical Center - Tucson, 1501 N. Campbell Ave., Tucson, AZ, 85724, USA.,Department of Hematology, Oncology, Blood & Marrow Transplantation, University of Arizona, Banner University Medical Center - Tucson, 1501 N. Campbell Ave., Tucson, AZ, 85724, USA
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Feldman DR, Huddart R, Hall E, Beyer J, Powles T. Is high dose therapy superior to conventional dose therapy as initial treatment for relapsed germ cell tumors? The TIGER Trial. J Cancer 2011; 2:374-7. [PMID: 21750688 PMCID: PMC3133961 DOI: 10.7150/jca.2.374] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Accepted: 06/15/2011] [Indexed: 11/05/2022] Open
Abstract
Metastatic germ cell tumours (GCTs) are usually cured with cisplatin based chemotherapy and standard treatment algorithms are established. However when this treatment fails and the disease relapses, standard treatment is much more uncertain. Both conventional dose therapy (CDT) and high dose therapy (HDT) are widely used, due to the lack of conclusive data supporting one specific approach. A recent retrospective analysis focusing on this population suggested a significant benefit for HDT. Retrospective analyses are prone to bias, and therefore while this data is provocative it is by no mean conclusive. For this reason the international community is supporting a prospective randomised trial in this area comparing CDT(TIP) with sequential HDT (TICE). The planned open labelled randomised phase III study (TIGER) is due to open in 2011 and will recruit 390 patients to detect a 13% difference in 2 year progression free survival (primary endpoint). It is hoped that this large study will conclusively resolve the uncertainty which currently exists.
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Affiliation(s)
- Darren R Feldman
- Genitourinary Oncology Service, Memorial Sloan-Kettering Cancer Center, New York USA
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Kobold S, Isernhagen J, Hübel K, Kilic N, Bogner C, Frickhofen N, Bokemeyer C, Fiedler W. Plerixafor is effective and safe for stem cell mobilization in heavily pretreated germ cell tumor patients. Bone Marrow Transplant 2010; 46:1053-6. [PMID: 21102500 DOI: 10.1038/bmt.2010.264] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Up to 10% of germ cell tumor patients require salvage high-dose chemotherapy with stem cell support, achieving cure rates in the range of 10-60%. Stem cell mobilization may be difficult in these patients because of multiple lines of treatment known to seriously hamper stem cell recovery. Plerixafor significantly enhances the success of the CD34+ cell harvest, even in cases where prior mobilization attempts have failed. Six germ cell tumor patients provided informed consent and were included in the compassionate use program. All patients were heavily pretreated, with a median of 3.5 prior lines of therapy. All failed prior mobilization with G-CSF in combination with chemotherapy. Five patients yielded a median of 2.6 × 10(6) CD34+ cells per kg body weight in a median of 4 apheresis days when plerixafor was used. Three patients underwent subsequent high-dose chemotherapy with autologous stem cell support. Median time to leukocyte engraftment was 11 days. Median time to platelet engraftment was 12.5 days, both of which are comparable to previous historical data. Accordingly, plerixafor seems to be safe and effective in germ cell tumor patients who have failed prior mobilization therapy. Larger prospective studies are warranted to further assess its use in germ cell cancer.
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Affiliation(s)
- S Kobold
- 1] Department of Oncology, Hematology, Stem Cell Transplantation with the section Pneumology, Department of Internal Medicine II, University Cancer Center Hamburg (Hubertus Wald Tumorzentrum), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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