High-Dose Chemotherapy and Stem-Cell Rescue for Metastatic Germ-Cell Tumors

[Karen]

NEJM Volume 357:340-348 July 26, 2007 Number 4

High-Dose Chemotherapy and Stem-Cell Rescue for Metastatic Germ-Cell Tumors
Lawrence H. Einhorn, M.D., Stephen D. Williams, M.D., Amy Chamness, B.A., Mary J. Brames, R.N., Susan M. Perkins, Ph.D., and Rafat Abonour, M.D.

Background: Metastatic testicular tumors that have not been successfully treated by means of initial chemotherapy are potentially curable with salvage chemotherapy.

Methods: We conducted a retrospective review of 184 consecutive patients with metastatic testicular cancer that had progressed after they received cisplatin-containing combination chemotherapy. We gave 173 patients two consecutive courses of high-dose chemotherapy consisting of 700 mg of carboplatin per square meter of body-surface area and 750 mg of etoposide per square meter, each for 3 consecutive days, and each followed by an infusion of autologous peripheral-blood hematopoietic stem cells; the other 11 patients received a single course of this treatment. In 110 patients, cytoreduction with one or two courses of vinblastine plus ifosfamide plus cisplatin preceded the high-dose chemotherapy.

Results: Of the 184 patients, 116 had complete remission of disease without relapse during a median follow-up of 48 months (range, 14 to 118). Of the 135 patients who received the treatment as second-line therapy, 94 were disease-free during follow-up; 22 of 49 patients who received treatment as third-line or later therapy were disease-free. Of 40 patients with cancer that was refractory to standard-dose platinum, 18 were disease-free. A total of 98 of 144 patients who had platinum-sensitive disease were disease-free, and 26 of 35 patients with seminoma and 90 of 149 patients with nonseminomatous germ-cell tumors were disease-free. Among the 184 patients, there were three drug-related deaths during therapy. Acute leukemia developed in three additional patients after therapy.

Conclusions: Testicular tumors are potentially curable by means of high-dose chemotherapy plus hematopoietic stem-cell rescue, even when this regimen is used as third-line or later therapy or in patients with platinum-refractory disease.

[Lori]

Karen, thanks for posting this. We had heard Dr. Einhorn was releasing a paper and since this pretty much describes my husband, we were really interested. Any chance you know how I can get the whole article?

Thanks, Lori

[Karen]

Hi Lori,
Due to the restrictions my company has on the NEJM license I can't send the full article, but if you e-mail Dr Einhorn, the corresponding author, he (actually his assistant) will send one to you. Include your mailing address and the citation in the request.

Address reprint requests to Dr. Einhorn at the Indiana University Cancer Center, 535 Barnhill Dr., Rm. 473, Indianapolis, IN 46202-5289, or at leinhorn@iupui.edu.

[Lori]

Hi Karen, I didn't even think of emailing Dr. E directly and he knows us well. I'll reach out to his assistance. Thank you

[Scott]

This report is getting quite a bit of coverage. Here are some samples:

• Indianapolis Star
• WebMD
• Science Daily

From the Science Daily article:

"The message for patients is that through research, diligence and new technologies there is hope," said Dr. Einhorn, professor of medicine at the Indiana University Melvin and Bren Simon Cancer Center and the lead author of the study. "The bar is steadily being raised and more patients are being saved."

[dadmo]

The story came up on my yahoo news today.

[Karen]

I'm so glad this is getting the press, especially competing with the NEJM "Perspective" on Oscar the Cat!

The cure may come in baby steps but damn, it's one step closer!

[Scott]

We discussed this briefly on the TC-NET mailing list, too. The study covers what we would consider to be standard second or third line treatment, not something groundbreaking.

The Indy Star article quotes Dr. Einhorn as saying:

"We still get problems from some insurance companies, saying that this is experimental, and having it with the imprimatur of the New England Journal of Medicine makes it easier for patients to get this therapy," he said. "Secondly, this is something that everybody in the world should be doing."

The presumed reason for publishing the study is to help ensure it is recognized as mainstream and to ease the path to have health insurance cover it.