First-line salvage treatment options for germ cell tumor patients failing stage-adapted primary treatment: A comprehensive review compiled by the German Testicular Cancer Study Group
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First-line salvage treatment options for germ cell tumor patients failing stage-adapted primary treatment: A comprehensive review compiled by the German Testicular Cancer Study Group. / Pfister, David; Oechsle, Karin; Schmidt, Stefanie; Busch, Jonas; Bokemeyer, Carsten; Heidenreich, Axel; Heinzelbecker, Julia; Ruf, Christian; Winter, Christian; Zengerling, Friedemann; Kliesch, Sabine; Albers, Peter; Oing, Christoph.
In: WORLD J UROL, Vol. 40, No. 12, 12.2022, p. 2853-2861.Research output: SCORING: Contribution to journal › SCORING: Review article › Research
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TY - JOUR
T1 - First-line salvage treatment options for germ cell tumor patients failing stage-adapted primary treatment: A comprehensive review compiled by the German Testicular Cancer Study Group
AU - Pfister, David
AU - Oechsle, Karin
AU - Schmidt, Stefanie
AU - Busch, Jonas
AU - Bokemeyer, Carsten
AU - Heidenreich, Axel
AU - Heinzelbecker, Julia
AU - Ruf, Christian
AU - Winter, Christian
AU - Zengerling, Friedemann
AU - Kliesch, Sabine
AU - Albers, Peter
AU - Oing, Christoph
N1 - © 2022. The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - PURPOSE: In this review, we summarize and discuss contemporary treatment standards and possible selection criteria for decision making after failure of adjuvant or first-line cisplatin-based chemotherapy for primarily localized or metastatic germ cell tumors.METHODS: This work is based on a systematic literature search conducted for the elaboration of the first German clinical practice guideline to identify prospective clinical trials and retrospective comparative studies published between Jan 2010 and Feb 2021. Study end points of interest were progression-free (PFS) and overall survival (OS), relapse rate (RR), and/or safety.RESULTS: Relapses of clinical stage I (CS I) patients irrespective of prior adjuvant treatment after orchiectomy are treated stage adapted in accordance for primary metastatic patients. Surgical approaches for sole retroperitoneal relapses are investigated in ongoing clinical trials. The appropriate salvage chemotherapy for metastatic patients progressing or relapsing after first-line cisplatin-based chemotherapy is still a matter of controversy. Conventional cisplatin-based chemotherapy is the international guideline-endorsed standard of care, but based on retrospective data high-dose chemotherapy and subsequent autologous stem cell transplantation may offer a 10-15% survival benefit for all patients. Secondary complete surgical resection of all visible residual masses irrespective of size is paramount for treatment success.CONCLUSIONS: Patients relapsing after definite treatment of locoregional disease are to be treated by stage-adapted first-line standard therapy for metastatic disease. Patients with primary advanced/metastatic disease failing one line of cisplatin-based combination chemotherapy should be referred to GCT expert centers. Dose intensity is a matter of ongoing debate, but sequential high-dose chemotherapy seems to improve patients' survival.
AB - PURPOSE: In this review, we summarize and discuss contemporary treatment standards and possible selection criteria for decision making after failure of adjuvant or first-line cisplatin-based chemotherapy for primarily localized or metastatic germ cell tumors.METHODS: This work is based on a systematic literature search conducted for the elaboration of the first German clinical practice guideline to identify prospective clinical trials and retrospective comparative studies published between Jan 2010 and Feb 2021. Study end points of interest were progression-free (PFS) and overall survival (OS), relapse rate (RR), and/or safety.RESULTS: Relapses of clinical stage I (CS I) patients irrespective of prior adjuvant treatment after orchiectomy are treated stage adapted in accordance for primary metastatic patients. Surgical approaches for sole retroperitoneal relapses are investigated in ongoing clinical trials. The appropriate salvage chemotherapy for metastatic patients progressing or relapsing after first-line cisplatin-based chemotherapy is still a matter of controversy. Conventional cisplatin-based chemotherapy is the international guideline-endorsed standard of care, but based on retrospective data high-dose chemotherapy and subsequent autologous stem cell transplantation may offer a 10-15% survival benefit for all patients. Secondary complete surgical resection of all visible residual masses irrespective of size is paramount for treatment success.CONCLUSIONS: Patients relapsing after definite treatment of locoregional disease are to be treated by stage-adapted first-line standard therapy for metastatic disease. Patients with primary advanced/metastatic disease failing one line of cisplatin-based combination chemotherapy should be referred to GCT expert centers. Dose intensity is a matter of ongoing debate, but sequential high-dose chemotherapy seems to improve patients' survival.
KW - Antineoplastic Combined Chemotherapy Protocols/therapeutic use
KW - Cisplatin/therapeutic use
KW - Hematopoietic Stem Cell Transplantation
KW - Humans
KW - Male
KW - Neoplasm Recurrence, Local/drug therapy
KW - Neoplasms, Germ Cell and Embryonal/drug therapy
KW - Prospective Studies
KW - Retrospective Studies
KW - Salvage Therapy
KW - Testicular Neoplasms/pathology
KW - Transplantation, Autologous
U2 - 10.1007/s00345-022-03959-8
DO - 10.1007/s00345-022-03959-8
M3 - SCORING: Review article
C2 - 35226138
VL - 40
SP - 2853
EP - 2861
JO - WORLD J UROL
JF - WORLD J UROL
SN - 0724-4983
IS - 12
ER -
