TY - JOUR
T1 - Salvage High-Dose Chemotherapy for Relapsed Pure Seminoma in the Last 10 Years: Results From the European Society for Blood and Marrow Transplantation Series 2002-2012
AU - Necchi, A.
AU - Vullo, S. Lo
AU - Bregni, M.
AU - Rosti, G.
AU - Mariani, L.
AU - Raggi, D.
AU - Giannatempo, P.
AU - Secondino, S.
AU - Schumacher, K.
AU - Massard, C.
AU - Kanfer, E.
AU - Oechsle, K.
AU - Laszlo, D.
AU - Michieli, M.
AU - Ifrah, N.
AU - Mercier, M.
AU - Crysandt, M.
AU - Wuchter, P.
AU - Nagler, A.
AU - Wahlin, A.
AU - Martino, M.
AU - Badoglio, M.
AU - Pedrazzoli, P.
AU - Lanza, F.
AU - Blood, European Society for
AU - Party, Marrow Transplantation (EBMT) Solid Tumors Working
N1 - LR: 20180113; CI: Copyright (c) 2016; JID: 101260955; 0 (Antineoplastic Agents); 6PLQ3CP4P3 (Etoposide); BG3F62OND5 (Carboplatin); OTO: NOTNLM; 2016/04/07 00:00 [received]; 2016/05/21 00:00 [revised]; 2016/06/11 00:00 [accepted]; 2016/07/23 06:00 [pubmed]; 2017/10/24 06:00 [medline]; 2016/07/23 06:00 [entrez]; ppublish
PY - 2017/2/1
Y1 - 2017/2/1
N2 - BACKGROUND: The optimal management of advanced seminoma that relapses after chemotherapy remains unknown. We retrospectively analyzed outcomes with the use of high-dose chemotherapy (HDCT). PATIENTS AND METHODS: Eligibility included adult male patients with pure seminomatous histology and treatment with salvage HDCT. Data of patients who received HDCT from 13 European Society for Blood and Marrow Transplantation (EBMT) centers were used. Multivariable Cox analyses evaluated the association of prespecified factors (line of treatment, prior radiotherapy, and chemosensitivity according to standard definition), with progression-free (PFS) and overall survival (OS). The prognostic ability of the model was assessed through the concordance statistic. RESULTS: From December 2002 to December 2012, 46 cases were identified. Median age was 38 years (interquartile range, 35-46 years). HDCT was provided as second-line therapy (n = 14, 30.4%) and in third-line or beyond third-line therapy (n = 20, 43.5%; 12 had missing information). Sixteen patients (34.8%) received paraortic and/or iliac radiotherapy, and 10 (21.7%) had disease that was cisplatin refractory or absolutely refractory. Median follow-up was 22 months (interquartile range, 8-56). On multivariable Cox analysis, refractory disease was a significantly negative prognostic factor for both PFS (hazard ratio, 6.04; 95% confidence interval, 1.86-19.64) and OS (hazard ratio, 3.93; 95% confidence interval, 1.07-14.45), while prior radiotherapy trended to significance for both. The c index was 0.74 and 0.66 for PFS and OS, respectively. The small numbers and the lack of any comparison with conventional-dose chemotherapy are major study limitations. CONCLUSION: Despite our small sample size, this retrospective analysis suggested that HDCT may represent a valuable therapeutic option for patients with a pure seminoma after standard-dose chemotherapy failure. Our observation requires validation through a prospective study.
AB - BACKGROUND: The optimal management of advanced seminoma that relapses after chemotherapy remains unknown. We retrospectively analyzed outcomes with the use of high-dose chemotherapy (HDCT). PATIENTS AND METHODS: Eligibility included adult male patients with pure seminomatous histology and treatment with salvage HDCT. Data of patients who received HDCT from 13 European Society for Blood and Marrow Transplantation (EBMT) centers were used. Multivariable Cox analyses evaluated the association of prespecified factors (line of treatment, prior radiotherapy, and chemosensitivity according to standard definition), with progression-free (PFS) and overall survival (OS). The prognostic ability of the model was assessed through the concordance statistic. RESULTS: From December 2002 to December 2012, 46 cases were identified. Median age was 38 years (interquartile range, 35-46 years). HDCT was provided as second-line therapy (n = 14, 30.4%) and in third-line or beyond third-line therapy (n = 20, 43.5%; 12 had missing information). Sixteen patients (34.8%) received paraortic and/or iliac radiotherapy, and 10 (21.7%) had disease that was cisplatin refractory or absolutely refractory. Median follow-up was 22 months (interquartile range, 8-56). On multivariable Cox analysis, refractory disease was a significantly negative prognostic factor for both PFS (hazard ratio, 6.04; 95% confidence interval, 1.86-19.64) and OS (hazard ratio, 3.93; 95% confidence interval, 1.07-14.45), while prior radiotherapy trended to significance for both. The c index was 0.74 and 0.66 for PFS and OS, respectively. The small numbers and the lack of any comparison with conventional-dose chemotherapy are major study limitations. CONCLUSION: Despite our small sample size, this retrospective analysis suggested that HDCT may represent a valuable therapeutic option for patients with a pure seminoma after standard-dose chemotherapy failure. Our observation requires validation through a prospective study.
KW - Adult
KW - Antineoplastic Agents/administration & dosage/therapeutic use
KW - Carboplatin/administration & dosage/therapeutic use
KW - Disease-Free Survival
KW - Etoposide/administration & dosage/therapeutic use
KW - Humans
KW - Male
KW - Middle Aged
KW - Prognosis
KW - Recurrence
KW - Retrospective Studies
KW - Salvage Therapy/methods
KW - Seminoma/drug therapy
KW - Survival Analysis
KW - Testicular Neoplasms/drug therapy
KW - Treatment Outcome
KW - High-dose chemotherapy
KW - Prognostic factors
KW - Salvage chemotherapy
KW - Seminoma
KW - Survival
U2 - S1558-7673(16)30164-1 [pii]
DO - S1558-7673(16)30164-1 [pii]
M3 - Article
VL - 15
SP - 163
EP - 167
JO - Clinical Genitourinary Cancer
JF - Clinical Genitourinary Cancer
SN - 1558-7673
IS - 1
ER -