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High dose chemotherapy with ifosfamide, carboplatin, and etoposide combined with autologous bone marrow transplantation for the treatment of poor‐prognosis germ cell tumors and metastatic trophoblastic disease in adults
Author(s) -
Lotz JeanPierre,
André Thierry,
Donsimoni Rita,
Firmin Colette,
Bouleuc Carole,
Bonnak Hingh,
Merad Zoher,
Esteso Adoracion,
Gerota Jean,
Izrael Victor
Publication year - 1995
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(19950201)75:3<874::aid-cncr2820750320>3.0.co;2-q
Subject(s) - carboplatin , medicine , ifosfamide , etoposide , germ cell tumors , regimen , progressive disease , chemotherapy , oncology , gastroenterology , urology , surgery , cisplatin
Background . A Phase I—II trial to assess the toxicity and efficacy of a tandem high dose chemotherapy combining ifosfamide, carboplatin, and etoposide in germ cell tumors and metastatic trophoblastic disease was performed. Methods . Thirty‐nine patients, with a total of 22 testicular tumors, 9 extragonadal germ cell tumors, 3 ovarian germ cell tumors, and 5 cases of metastatic trophoblastic disease, received tandem high dose therapy combining ifosfamide (7500‐12,500 mg/m 2 ), carboplatin (875‐1225 mg/m 2 ), and etoposide (1000‐1250 mg/m 2 ), followed by bone marrow reinfusion. Among the 39 patients, 33 were refractory to cisplatin‐ or carboplatin‐based regimen and the response of 37 could be evaluated; 69 cycles of this tandem high dose therapy were administered. Results . The overall response rate was 46%, including a complete response (CR) rate of 35%. Of 21 patients with testicular tumors who could be evaluated, 10 (47%) achieved a CR. No CRs were obtained in patients with refractory extragonadal germ cell tumors. Nine partial responders after the first cycle became complete responders after the second. Nine (23%) of the patients were long term survivors (> 18 months), 7 of them in continuous CR. Side effects primarily were renal toxicity and entero‐colitis. Seven patients (18%) died of therapy‐related causes. The therapeutic contribution of ifosfamide must be explored and the maximum tolerated doses of this three‐drug regimen remain to be determined. Conclusion . This tandem therapeutic regimen is able to overcome resistance to a platinum‐based regimen in highly refractory germ cell tumors and gestational trophoblastic disease and to cure a number of patients. Cancer 1995; 75:874—85.