High-Dose Chemotherapy Outcomes in Men With Germ Cell Cancer

A new study from the Swedish and Norwegian Testicular Cancer Group (SWENOTECA) cancer care program sought to evaluate survival and toxicity in patients treated with high-dose chemotherapy (HDCT) from 2011 through 2021.

Results are being presented by Anna Jansson, MD, of Uppsala University, and colleagues at the 2024 American Society of Clinical Oncology Annual Meeting.

Patients with advanced germ cell tumors tend to have a poor prognosis, including those with brain, bone, or liver metastasis, as well as those with elevated tumor markers or primary mediastinal tumors. HDCT with autologous stem cell support is recommended in the SWENOTECA guidelines for poor-risk patients with poor response to and relapse after intense primary treatment. Since 2011, the HDCT regimen has consisted of 2 cycles of carboplatin and etoposide.

Dr. Jansson and colleagues designed a study to better understand survival and toxicity in patients treated with HDCT within the population-based SWENOTECA cancer care program from 2011 through 2021. A total of 80 patients were included in the analysis, 76 of whom had nonseminoma disease. HDCT was administered in 3 different clinical situations:

1. Delayed tumor marker decline during primary or intensified primary treatment (n=26)
2. Progressive disease during primary treatment (n=29)
3. Relapse with poor prognosis (n=25)

Five-year overall survival (OS) and failure-free survival (FFS) after HDCT was 55% and 43%, respectively. Researchers noted that HDCT administration due to delayed tumor marker was associated with more favorable outcomes (5-year OS, 75%; 5-year FFS, 53%) compared with HDCT administration due to progressive disease (5-year OS, 29%; 5-year FFS, 18%) and HDCT administration due to relapse (5-year OS, 61%; 5-year FFS, 58%).

Dr. Jansson and colleagues acknowledged that 4 patients died due to treatment, and the most common treatment-related grade 3/4 toxicity was infection (86%).

“In this population-based study, we have shown that HDCT for patients with advanced germ cell cancer according to the SWENOTECA cancer care program is achievable and leads to favorable OS and FFS rates,” study authors concluded, adding that “even though patients [who] receive HDCT due to progressive disease have a relatively poor outcome, 20% to 30% of patients do achieve long-term survival.”