Paclitaxel-based high-dose chemotherapy with autologous stem cell rescue for relapsed germ cell cancer
| Autor: | Przemyslaw Twardowski, George Somlo, Warren Chow, Jeffrey Schriber, Neil Kogut, Susan Stalter, Lucille Leong, Yun Yen, James H. Doroshow, Mark McNamara, Paul Frankel, Robert J. Morgan, Kim Margolin, Joseph C. Alvarnas, Dean Lim, Stephen Shibata |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
Oncology
Adult Male medicine.medical_specialty Adolescent Paclitaxel medicine.medical_treatment Germ cell tumors Transplantation Autologous Carboplatin chemistry.chemical_compound Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine High-dose chemotherapy Humans Ifosfamide Etoposide Mesna Salvage Therapy Chemotherapy Transplantation Peripheral Blood Stem Cell Transplantation business.industry Hematopoietic Stem Cell Transplantation Hematology Middle Aged Neoplasms Germ Cell and Embryonal medicine.disease Prognosis Survival Analysis Peripheral stem cell transplantation Surgery Treatment Outcome chemistry Female business medicine.drug Autologous peripheral stem cell support |
| Zdroj: | Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 11(11) |
| ISSN: | 1083-8791 |
| Popis: | We evaluated the antitumor activity of tandem cycles of high-dose chemotherapy with autologous peripheral stem cell transplantation (aPSCT) in relapsed germ cell tumors by using high-dose paclitaxel, carboplatin, etoposide, and ifosfamide. Thirty-three patients were entered, and 31 underwent protocol therapy. Paclitaxel 350 mg/m2 (5 patients) or 425 mg/m2 (26 patients) by 24-hour continuous intravenous infusion was followed by 3 daily doses of carboplatin and either etoposide (cycle 1) or ifosfamide/mesna (cycle 2). The carboplatin dose had a calculated area under the curve of 7 mg-min/mL, and the daily dose of etoposide was 20 mg/kg (cycle 1). Ifosfamide 3 g/m2/d for 3 days (with mesna uroprotection) was substituted for etoposide in cycle 2. Each cycle was supported by granulocyte colony-stimulating factor–mobilized peripheral blood stem cells. Thirty-one patients were evaluable for response, toxicity, and long-term disease control. Two patients did not undergo aPSCT because of rapid disease progression. Nineteen patients received both cycles of aPSCT, 8 progressed after cycle 1, 3 refused the second cycle, and 1 died of fungal infection during cycle 1. Twelve patients remain relapse free at a median of 67 months from the initiation of therapy. Whereas the International Germ Cell Cancer Collaborative Group category at the time of initial diagnosis did not seem to predict outcome, the patient's probability of achieving durable remission was significantly associated with the Beyer prognostic score at the time of protocol entry. Regimens containing the most active agents in relapsed nonseminomatous germ cell tumors, including high-dose paclitaxel, are well tolerated and have promising activity even in patients with poor-risk features who do not achieve durable remissions with standard therapy. The Beyer prognostic system is a valuable predictor for patients undergoing aPSCT. |
| Databáze: | OpenAIRE |
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