AI Article Synopsis
- This review focuses on treatment strategies and criteria for patients who have not responded to initial cisplatin-based chemotherapy for germ cell tumors, including both localized and metastatic cases.
- A systematic literature search identified relevant studies from Jan 2010 to Feb 2021, with outcomes of interest related to survival rates, relapse rates, and safety across treatments.
- The findings indicate that while standard cisplatin treatment remains the norm, high-dose chemotherapy and surgical options may improve survival in certain cases, and expert centers should manage those with more complicated cases.
Article Abstract
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.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9712404 | PMC |
| http://dx.doi.org/10.1007/s00345-022-03959-8 | DOI Listing |
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