TI-CE high-dose chemotherapy for patients with previously treated germ cell tumors: results and prognostic factor analysis.
Purpose: We previously reported a dose-finding and phase II trial of the TI-CE regimen (paclitaxel [T] plus ifosfamide [I] followed by high-dose carboplatin [C] plus etoposide [E] with stem-cell support) in germ cell tumor (GCT) patients predicted to have a poor prognosis with conventional-dose salv...
| Publicado en: | Journal of Clinical Oncology Vol. 28; no. 10; pp. 1706 - 1714 |
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| Autores principales: | , , , , , , , , , , , , , , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
American Society of Clinical Oncology
4/1/2010
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105159997&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 105159997 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 0732183X 20D jtl: Journal of Clinical Oncology issn: 0732183X maglogo: N pubinfo: dt: 4/1/2010 vid: 28 iid: 10 pid: 26892 pub: American Society of Clinical Oncology place: Alexandria, Virginia artinfo: ui: 105159997 NLM20194867 2010610185 10.1200/JCO.2009.25.1561 NLM20194867 PMC3651604 105159997 ppf: 1706 ppct: 8 formats: tig: atl: TI-CE high-dose chemotherapy for patients with previously treated germ cell tumors: results and prognostic factor analysis. aug: au: Feldman DR Sheinfeld J Bajorin DF Fischer P Turkula S Ishill N Patil S Bains M Reich LM Bosl GJ Motzer RJ Feldman, Darren R Sheinfeld, Joel Bajorin, Dean F Fischer, Patricia Turkula, Stefan Ishill, Nicole Patil, Sujata Bains, Manjit Reich, Lilian M affil: Genitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA sug: subj: Antineoplastic Agents, Combined Therapeutic Use Neoplasms, Germ Cell and Embryonal Drug Therapy Adolescence Adult Carboplatin Administration and Dosage Combined Modality Therapy Etoposide Administration and Dosage Female Hematopoietic Stem Cell Transplantation Human Ifosfamide Administration and Dosage Male Middle Age Paclitaxel Administration and Dosage Prognosis Repeat Procedures Salvage Therapy Adolescent: 13-18 years Adult: 19-44 years Middle Aged: 45-64 years Female Male ab: Purpose: We previously reported a dose-finding and phase II trial of the TI-CE regimen (paclitaxel [T] plus ifosfamide [I] followed by high-dose carboplatin [C] plus etoposide [E] with stem-cell support) in germ cell tumor (GCT) patients predicted to have a poor prognosis with conventional-dose salvage therapy. We now report the efficacy of TI-CE with prognostic factors for disease-free survival (DFS) and overall survival (OS) in our full data set of 107 patients.Patients and Methods: Eligible patients had advanced GCTs with progressive disease following chemotherapy and unfavorable prognostic features (extragonadal primary site, incomplete response [IR] to first-line therapy, or relapse/IR to ifosfamide-cisplatin-based conventional-dose salvage). Univariate and multivariate analyses (MVAs) of prognostic factors were performed. The predictive ability of the Einhorn and Beyer prognostic models was assessed.Results: Most patients were platinum refractory and had an IR to first-line chemotherapy. There were 54 (5%) complete and eight (8%) partial responses with negative markers; 5-year DFS was 47% and OS was 52% (median follow-up, 61 months). No relapses occurred after 2 years. Five (24%) of 21 primary mediastinal nonseminomatous GCTs are continuously disease free. On MVA, primary mediastinal site (P < .001), two or more lines of prior therapy (P < .001), baseline human chorionic gonadotropin > or = 1,000 U/L (P = .01), and lung metastases (P = .02) significantly predicted adverse DFS. Poor-risk patients did worse than good- or intermediate-risk patients according to both Beyer (P < .002) and Einhorn (P < .05) models.Conclusion: TI-CE is effective salvage therapy for GCT patients with poor prognostic features. Mediastinal primary site and two or more lines of prior therapy were most predictive of adverse DFS. Beyer and Einhorn models can assist in predicting outcome. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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