Objectives: We aimed to analyze the predictors of outcome in metastatic germ cell cancer (MGCC) patients treated with High-dose Chemotherapy (HDC) and stem cell rescue.
Background: Various prognostic factors have been suggested in the treatment of metastatic germ cell cancer. However, there is no comprehensive evaluation of independent prognostic factors for the efficacy of HDC in published patient cohorts.
Methods: Thirty-two published patient cohorts with MGCC (encompassing 2176 patients; 510 patients treated upfront and 1666 at relapse) were identified from PUBMED and Cochrane Registry of Clinical Trials. Weighted Regression Analyses of these trials were conducted to define prognosticators.
Results: Independent correlates of overall survival (OAS) when all trials were considered were line of chemotherapy index, an indicator of line of HDC utilization (1st line: 71% vs 2nd or higher line: 40%, p < 0.001), and number of HDC cycles administered (1 cycle: 43%, 1 to 2 cycles: 43%, 2 or more cycles: 64%, p = 0.021). In cohorts having HDC for relapsed disease, lower line of chemotherapy index again (p = 0.004), and higher median age (p = 0.023) were independently associated with better OAS. In trials utilizing upfront HDC, higher number of chemotherapeutics in the HDC regimen was marginally linked with improved OAS (p = 0.047).
Conclusion: The efficacy of various forms of HDC in MGCC patients with diverse prognostic factors may vary both as an initial or salvage therapy. Clinicians need to be aware of these factors for optimal patient selection for HDC in MGCC (Tab. 3, Fig. 2, Ref. 54).
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