High-dose chemotherapy and autologous haematopoietic support in poor risk non-seminomatous germ-cell tumours: an effective first-line therapy with minimal toxicity.
dc.contributor.author | Decatris, M P | |
dc.contributor.author | Wilkinson, Peter M | |
dc.contributor.author | Welch, Richard | |
dc.contributor.author | Metzner, M | |
dc.contributor.author | Morgenstern, Godfrey R | |
dc.contributor.author | Dougal, Mark | |
dc.date.accessioned | 2009-11-19T15:16:16Z | |
dc.date.available | 2009-11-19T15:16:16Z | |
dc.date.issued | 2000-04 | |
dc.identifier.citation | High-dose chemotherapy and autologous haematopoietic support in poor risk non-seminomatous germ-cell tumours: an effective first-line therapy with minimal toxicity. 2000, 11 (4):427-34 Ann. Oncol. | en |
dc.identifier.issn | 0923-7534 | |
dc.identifier.pmid | 10847461 | |
dc.identifier.uri | http://hdl.handle.net/10541/86471 | |
dc.description.abstract | BACKGROUND: The prognosis of patients with high-risk germ-cell cancer is poor. The toxicity and efficacy of first-line high-dose chemotherapy (HDCT) with stem-cell support was evaluated, following induction chemotherapy with BEP. PATIENTS AND METHODS: Twenty patients with poor prognosis non seminomatous germ-cell tumour by the International Consensus prognostic criteria received induction with BEP followed by one cycle of HDCT (CEC) given with carboplatin (1800 mg/m2), etoposide (1800 mg/m2), and cyclophosphamide (140 mg/kg). Of the above 20 patients only 3 received a second cycle of HDCT. Peripheral blood stem cells were infused on day 0. RESULTS: Twenty patients were assessable for toxicity and response. After a median follow-up of 27 months 15 patients (75%) are alive, 12 (60%) are disease free and 3 (15%) are alive with disease. Median survival has not been reached and overall survival at four years is 66% with a durable complete response rate of 50%. There were no deaths or cases of severe toxicity. Median time to a granulocyte count > 500/microl and platelets > 20,000/microl was 10 and 12 days respectively. Five patients have died from progressive disease 5-35 months after HDCT. CONCLUSIONS: These results support the case of first-line HDCT. The excellent toxicity profile of BEP/CEC and the two-year overall survival of 78% are encouraging and support further the ongoing randomised US intergroup study evaluating high-dose CEC after BEP. | |
dc.language.iso | en | en |
dc.subject | Germ Cell and Embryonal Cancer | en |
dc.subject | Haematopoietic Stem Cell Transplantation | en |
dc.subject.mesh | Adolescent | |
dc.subject.mesh | Adult | |
dc.subject.mesh | Antineoplastic Combined Chemotherapy Protocols | |
dc.subject.mesh | Bleomycin | |
dc.subject.mesh | Carboplatin | |
dc.subject.mesh | Cisplatin | |
dc.subject.mesh | Combined Modality Therapy | |
dc.subject.mesh | Cyclophosphamide | |
dc.subject.mesh | Dose-Response Relationship, Drug | |
dc.subject.mesh | Drug Administration Schedule | |
dc.subject.mesh | Etoposide | |
dc.subject.mesh | Female | |
dc.subject.mesh | Hematopoietic Stem Cell Transplantation | |
dc.subject.mesh | Humans | |
dc.subject.mesh | Male | |
dc.subject.mesh | Middle Aged | |
dc.subject.mesh | Neoplasms, Germ Cell and Embryonal | |
dc.subject.mesh | Risk Factors | |
dc.subject.mesh | Survival Analysis | |
dc.subject.mesh | Treatment Outcome | |
dc.title | High-dose chemotherapy and autologous haematopoietic support in poor risk non-seminomatous germ-cell tumours: an effective first-line therapy with minimal toxicity. | en |
dc.type | Article | en |
dc.contributor.department | Department of Clinical Oncology, Christie Hospital NHS Trust, Manchester, UK. | en |
dc.identifier.journal | Annals of Oncology | en |
html.description.abstract | BACKGROUND: The prognosis of patients with high-risk germ-cell cancer is poor. The toxicity and efficacy of first-line high-dose chemotherapy (HDCT) with stem-cell support was evaluated, following induction chemotherapy with BEP. PATIENTS AND METHODS: Twenty patients with poor prognosis non seminomatous germ-cell tumour by the International Consensus prognostic criteria received induction with BEP followed by one cycle of HDCT (CEC) given with carboplatin (1800 mg/m2), etoposide (1800 mg/m2), and cyclophosphamide (140 mg/kg). Of the above 20 patients only 3 received a second cycle of HDCT. Peripheral blood stem cells were infused on day 0. RESULTS: Twenty patients were assessable for toxicity and response. After a median follow-up of 27 months 15 patients (75%) are alive, 12 (60%) are disease free and 3 (15%) are alive with disease. Median survival has not been reached and overall survival at four years is 66% with a durable complete response rate of 50%. There were no deaths or cases of severe toxicity. Median time to a granulocyte count > 500/microl and platelets > 20,000/microl was 10 and 12 days respectively. Five patients have died from progressive disease 5-35 months after HDCT. CONCLUSIONS: These results support the case of first-line HDCT. The excellent toxicity profile of BEP/CEC and the two-year overall survival of 78% are encouraging and support further the ongoing randomised US intergroup study evaluating high-dose CEC after BEP. |