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Salvage chemotherapy for patients with germ cell tumors. The memorial sloan‐kettering cancer center experience (1979–1989)
Author(s) -
Motzer Robert J.,
Geller Nancy L.,
Tan Claire C.Y.,
Herr Harry,
Morse Michael,
Fair William,
Sheinfeld Joel,
Sogani Pramod,
Russo Paul,
Bosl George J.
Publication year - 1991
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19910301)67:5<1305::aid-cncr2820670506>3.0.co;2-j
Subject(s) - medicine , salvage therapy , chemotherapy , regimen , surgery , germ cell tumors , induction chemotherapy , cisplatin , metastasis , oncology , cancer , chemotherapy regimen
Twenty‐eight of 124 (23%) advanced germ cell tumor (GCT) patients who were treated on four successive platin‐based induction regimens and who failed to achieve a durable complete response (CR) remain alive (median follow‐up, 50 months). An analysis of prognostic factors for response and survival was conducted on the 94 patients who received salvage chemotherapy. Survival and/or response to salvage therapy were significantly enhanced for patients with a prior CR to induction chemotherapy, treatment with a cisplatin‐based salvage regimen, a testis primary site, a normal serum human chorionic gonadotropin level, a normal serum lactate dehydrogenase level, one site of metastasis, and an Indiana Class of 6 or less. Patients with a prior incomplete response (IR) had a particularly poor prognosis ( P = 0.00007) with only 4 of 52 (9%) patients alive (median follow‐up, 37 months) compared with 15 of 42 (36%) patients with a prior best response of a CR (median follow‐up, 35 months). The poor survival of patients who fail to achieve a durable CR to induction chemotherapy warrants the continued investigation of new salvage therapy. The identification of prognostic features may direct salvage therapy and aid in the interpretation of clinical trials of salvage regimens.