Journal of Clinical Oncology, Vol 15, 2559-2563, Copyright © 1997 by American Society of Clinical Oncology

ARTICLES

Ifosfamide- and cisplatin-containing chemotherapy as first-line salvage therapy in germ cell tumors: response and survival

JA McCaffrey, M Mazumdar, DF Bajorin, GJ Bosl, V Vlamis and RJ Motzer
Department of Medicine, Memorial Sloan-Kettering Cancer Center, Cornell University Medical College, New York, NY 10021, USA. mccaffrj@mskcc.org

PURPOSE: To evaluate the efficacy and toxicity of ifosfamide- and cisplatin-containing chemotherapy as first-line salvage treatment for patients with germ cell tumors (GCT). PATIENTS AND METHODS: Fifty-six patients with advanced GCT resistant to one prior cisplatin-containing regimen were treated with a salvage chemotherapy regimen of ifosfamide, cisplatin, and either vinblastine or etoposide (VeIP/VIP). RESULTS: Twenty of 56 (36%) assessable patients achieved a complete response (CR). Thirteen (23%) are alive and continuously free of disease at a median follow-up time of 52 months; the median survival duration was 18 months. Among patients with a testis primary tumor site and a prior CR to first-line therapy, 65% are alive and 41% continuously disease-free, and the median survival time has not been reached. In contrast, for patients with an extragonadal primary tumor or with a testis primary tumor site and an incomplete response (IR) to first-line therapy, 31% are alive and 15% continuously free of disease, with a median survival time of 12 months (P < .03). CONCLUSION: Ifosfamide- and cisplatin- containing therapy achieves a durable CR in a minority of patients with resistant GCT as first-line therapy. Patients with a primary testis site who relapsed from a CR to first-line cisplatin therapy have a better prognosis than patients with an extragonadal primary tumor site or an IR to first-line therapy. Risk-directed clinical trials to improve response and survival in both subsets are warranted.

This article has been cited by other articles:

				D. R. Feldman, G. J. Bosl, J. Sheinfeld, and R. J. Motzer Medical Treatment of Advanced Testicular Cancer JAMA, February 13, 2008; 299(6): 672 - 684. [Abstract] [Full Text] [PDF]

				A. J. Stephenson, G. J. Bosl, R. J. Motzer, D. F. Bajorin, J. P. Stasi, and J. Sheinfeld Nonrandomized Comparison of Primary Chemotherapy and Retroperitoneal Lymph Node Dissection for Clinical Stage IIA and IIB Nonseminomatous Germ Cell Testicular Cancer J. Clin. Oncol., December 10, 2007; 25(35): 5597 - 5602. [Abstract] [Full Text] [PDF]

				D. M. Gershenson Management of Ovarian Germ Cell Tumors J. Clin. Oncol., July 10, 2007; 25(20): 2938 - 2943. [Abstract] [Full Text] [PDF]

				G. Sonpavde, T. E. Hutson, and B. J. Roth Management of Recurrent Testicular Germ Cell Tumors Oncologist, January 1, 2007; 12(1): 51 - 61. [Abstract] [Full Text] [PDF]

				G. V. Kondagunta and R. J. Motzer Chemotherapy for Advanced Germ Cell Tumors J. Clin. Oncol., December 10, 2006; 24(35): 5493 - 5502. [Abstract] [Full Text] [PDF]

				J. Oldenburg, J. M. Martin, and S. D. Fossa Late Relapses of Germ Cell Malignancies: Incidence, Management, and Prognosis J. Clin. Oncol., December 10, 2006; 24(35): 5503 - 5511. [Abstract] [Full Text] [PDF]

				K. Kawai, S. Ando, S. Hinotsu, T. Oikawa, N. Sekido, N. Miyanaga, T. Shimazui, and H. Akaza Completion and Toxicity of Induction Chemotherapy for Metastatic Testicular Cancer: An Updated Evaluation of Japanese Patients Jpn. J. Clin. Oncol., July 1, 2006; 36(7): 425 - 431. [Abstract] [Full Text] [PDF]

				E. A. Ronnen, G. V. Kondagunta, J. Bacik, S. Marion, D. F. Bajorin, J. Sheinfeld, G. J. Bosl, and R. J. Motzer Incidence of Late-Relapse Germ Cell Tumor and Outcome to Salvage Chemotherapy J. Clin. Oncol., October 1, 2005; 23(28): 6999 - 7004. [Abstract] [Full Text] [PDF]

				G. V. Kondagunta, J. Bacik, A. Donadio, D. Bajorin, S. Marion, J. Sheinfeld, G. J. Bosl, and R. J. Motzer Combination of Paclitaxel, Ifosfamide, and Cisplatin Is an Effective Second-Line Therapy for Patients With Relapsed Testicular Germ Cell Tumors J. Clin. Oncol., September 20, 2005; 23(27): 6549 - 6555. [Abstract] [Full Text] [PDF]

				J.-P. Lotz, B. Bui, F. Gomez, C. Theodore, A. Caty, K. Fizazi, G. Gravis, R. Delva, J. Peny, P. Viens, et al. Sequential high-dose chemotherapy protocol for relapsed poor prognosis germ cell tumors combining two mobilization and cytoreductive treatments followed by three high-dose chemotherapy regimens supported by autologous stem cell transplantation. Results of the phase II multicentric TAXIF trial Ann. Onc., March 1, 2005; 16(3): 411 - 418. [Abstract] [Full Text] [PDF]

				R. J. Motzer and J. Sheinfeld Poor-Risk Testicular Cancer and High-Dose Chemotherapy J. Clin. Oncol., November 15, 2003; 21(22): 4073 - 4074. [Full Text] [PDF]

				J. Miyazaki, K. Kawai, H. Hayashi, M. Onozawa, S. Tsukamoto, N. Miyanaga, S. Hinotsu, T. Shimazui, and H. Akaza The Limited Efficacy of Methotrexate, Actinomycin D and Cisplatin (MAP) for Patients with Advanced Testicular Cancer Jpn. J. Clin. Oncol., August 1, 2003; 33(8): 391 - 395. [Abstract] [Full Text] [PDF]

				K. Kawai, J. Miyazaki, S. Tsukamoto, S. Hinotsu, K. Hattori, T. Shimazui, and H. Akaza Paclitaxel, Ifosfamide and Cisplatin Regimen is Feasible for Japanese Patients with Advanced Germ Cell Cancer Jpn. J. Clin. Oncol., March 1, 2003; 33(3): 127 - 131. [Abstract] [Full Text] [PDF]

				J. Beyer, S. Stenning, A. Gerl, S. Fossa, and W. Siegert High-dose versus conventional-dose chemotherapy as first-salvage treatment in patients with non-seminomatous germ-cell tumors: a matched-pair analysis Ann. Onc., April 1, 2002; 13(4): 599 - 605. [Abstract] [Full Text] [PDF]

				J. Vuky, S. K. Tickoo, J. Sheinfeld, J. Bacik, A. Amsterdam, M. Mazumdar, V. Reuter, D. F. Bajorin, G. J. Bosl, and R. J. Motzer Salvage Chemotherapy for Patients With Advanced Pure Seminoma J. Clin. Oncol., January 1, 2002; 20(1): 297 - 301. [Abstract] [Full Text] [PDF]

				D. T. Schneider, R. Wessalowski, G. Calaminus, H. Pape, M. Bamberg, J. Engert, K. Waag, H. Gadner, and U. Gobel Treatment of Recurrent Malignant Sacrococcygeal Germ Cell Tumors: Analysis of 22 Patients Registered in the German Protocols MAKEI 83/86, 89, and 96 J. Clin. Oncol., April 1, 2001; 19(7): 1951 - 1960. [Abstract] [Full Text] [PDF]

				F. Rabbani, J. Sheinfeld, H. Farivar-Mohseni, A. Leon, M. J. Rentzepis, V. E. Reuter, H. W. Herr, J. A. McCaffrey, R. J. Motzer, D. F. Bajorin, et al. Low-Volume Nodal Metastases Detected at Retroperitoneal Lymphadenectomy for Testicular Cancer: Pattern and Prognostic Factors for Relapse J. Clin. Oncol., April 1, 2001; 19(7): 2020 - 2025. [Abstract] [Full Text] [PDF]

				O. Rick, C. Bokemeyer, J. Beyer, J. T. Hartmann, N. Schwella, D. Kingreen, S. Neureither, B. Metzner, J. Casper, H. Wandt, et al. Salvage Treatment With Paclitaxel, Ifosfamide, and Cisplatin Plus High-Dose Carboplatin, Etoposide, and Thiotepa Followed by Autologous Stem-Cell Rescue in Patients With Relapsed or Refractory Germ Cell Cancer J. Clin. Oncol., January 1, 2001; 19(1): 81 - 88. [Abstract] [Full Text] [PDF]

				R. J. Motzer, J. Sheinfeld, M. Mazumdar, M. Bains, T. Mariani, J. Bacik, D. Bajorin, and G. J. Bosl Paclitaxel, Ifosfamide, and Cisplatin Second-Line Therapy for Patients With Relapsed Testicular Germ Cell Cancer J. Clin. Oncol., June 12, 2000; 18(12): 2413 - 2418. [Abstract] [Full Text] [PDF]

				R. J. Motzer, M. Mazumdar, J. Sheinfeld, D. F. Bajorin, H. A. Macapinlac, M. Bains, L. Reich, C. Flombaum, T. Mariani, W. P. Tong, et al. Sequential Dose-Intensive Paclitaxel, Ifosfamide, Carboplatin, and Etoposide Salvage Therapy for Germ Cell Tumor Patients J. Clin. Oncol., March 13, 2000; 18(6): 1173 - 1180. [Abstract] [Full Text] [PDF]