High-dose chemotherapy (HDCT) in relapsed or refractory metastatic germ cell cancer: the Scotland experience.


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Yun Yi Tan1,Bahaa Al-Bubseeree1,David Irvine2,Graham MacDonald3,Grant McQuaker2,Anne Parker2,Ashita Waterston1,Jeff White1
1Beatson West of Scotland Cancer Centre,2Queen Elizabeth University Hospital, NHS GGC,3Aberdeen Royal Infirmary, NHS Grampian

Abstract

Background

HDCT followed by autologous stem cell transplant (ASCT) has been explored as salvage treatment for relapsed metastatic germ cell cancer. This retrospective study reports outcomes from HDCT and ASCT for relapsed or refractory metastatic germ cell cancer in Scotland. 

Method

All germ cell patients who underwent HDCT and ASCT between years 2001-2016 at the Beatson West of Scotland Cancer Centre (BWOSCC) in Glasgow were identified. Information regarding baseline patient and tumour characteristics, prognostic features at relapse as per International Prognostic Factor Study Group (IPFSG) risk categorisation, HDCT delivery and survival outcomes were obtained from patients’ medical records.

Results

18 patients (15 male and 3 female) received HDCT and ASCT in the salvage setting. Of the 14 male patients with relapsed disease, 8 (57%) were high or very high risk according to the IPFSG risk categorisation. 66% of patients received carboplatin and etoposide as per the Einhorn HDCT regimen1. The mean time interval between HDCT cycles was 8.5 weeks, which is longer than the specified 3-4 weeks in the literature. 67% of patients had no biochemical or radiological evidence of disease following salvage treatment, including surgery. The progression-free survival and overall survival rates at 2 years were 67% and 72% respectively. However, 67% and 39% of patients have long-term neurotoxicity and ototoxicity respectively.

Conclusion

Delivery of HDCT and ASCT as salvage treatment for metastatic germ cell cancer is feasible within a tertiary cancer centre with survival outcomes comparable to published literature although maintaining dose intensity is a challenge. The international TIGER trial (NCT02375204)2 which will attempt to clarify if HDCT is superior to conventional-dose chemotherapy in the salvage setting has opened in UK centres. Our result confirms clinical feasibility for delivery of trial treatment and will hopefully encourage recruitment in participating centres, including BWOSCC.