Onkológia 3/2024

Salvage treatment high-dose chemotherapy in testicular germ cell tumors

Relapsed testicular germ cell tumors (GCTs) can potentially be cured with salvage chemotherapy. The two main salvage treatment options are conventional-dose chemotherapy (CDCT) and high-dose chemotherapy (HDCT). HDCT combined with peripheral blood stem cell transplant (PBSCT) may offer a higher rate of durable responses compared to CDCT. This review discusses studies reporting outcomes of salvage HDCT in relapsed GCTs. The most consistent results were seen with HDCT involving two cycles of etoposide and carboplatin, or three cycles of the TICE regimen (paclitaxel, ifosfamide, carboplatin, and etoposide). Using these regimens, sustained cure rates of 50–66% have been reported in phase I, phase II, and retrospective studies over the past twenty years. For patients with cisplatin-resistant disease, cure rates range from 30% to 45%. Two phase III randomized studies, which had certain limitations, failed to show a survival benefit for HDCT. As a result, salvage treatment remains a topic of debate. Both HDCT with PBSCT and CDCT are recommended treatment options for relapsed GCTs. Consistently reported cure rates from phase I, phase II, and large retrospective studies support the use of HDCT by an experienced oncology team.

Keywords: testicular germ cell tumors, salvage treatment, high-dose chemotherapy