Pfister, David, Oechsle, Karin, Schmidt, Stefanie, Busch, Jonas, Bokemeyer, Carsten, Heidenreich, Axel, Heinzelbecker, Julia ORCID: 0000-0001-8993-7171, Ruf, Christian, Winter, Christian, Zengerling, Friedemann, Kliesch, Sabine, Albers, Peter and Oing, Christoph (2022). First-line salvage treatment options for germ cell tumor patients failing stage-adapted primary treatment A comprehensive review compiled by the German Testicular Cancer Study Group. World J. Urol., 40 (12). S. 2853 - 2862. NEW YORK: SPRINGER. ISSN 1433-8726

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Abstract

Purpose In this review, we summarize and discuss contemporary treatment standards and possible selection criteria for decision making after failure of adjuvant or first-line cisplatin-based chemotherapy for primarily localized or metastatic germ cell tumors. Methods This work is based on a systematic literature search conducted for the elaboration of the first German clinical practice guideline to identify prospective clinical trials and retrospective comparative studies published between Jan 2010 and Feb 2021. Study end points of interest were progression-free (PFS) and overall survival (OS), relapse rate (RR), and/or safety. Results Relapses of clinical stage I (CS I) patients irrespective of prior adjuvant treatment after orchiectomy are treated stage adapted in accordance for primary metastatic patients. Surgical approaches for sole retroperitoneal relapses are investigated in ongoing clinical trials. The appropriate salvage chemotherapy for metastatic patients progressing or relapsing after first-line cisplatin-based chemotherapy is still a matter of controversy. Conventional cisplatin-based chemotherapy is the international guideline-endorsed standard of care, but based on retrospective data high-dose chemotherapy and subsequent autologous stem cell transplantation may offer a 10-15% survival benefit for all patients. Secondary complete surgical resection of all visible residual masses irrespective of size is paramount for treatment success. Conclusions Patients relapsing after definite treatment of locoregional disease are to be treated by stage-adapted first-line standard therapy for metastatic disease. Patients with primary advanced/metastatic disease failing one line of cisplatin-based combination chemotherapy should be referred to GCT expert centers. Dose intensity is a matter of ongoing debate, but sequential high-dose chemotherapy seems to improve patients' survival.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Pfister, DavidUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Oechsle, KarinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schmidt, StefanieUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Busch, JonasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bokemeyer, CarstenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Heidenreich, AxelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Heinzelbecker, JuliaUNSPECIFIEDorcid.org/0000-0001-8993-7171UNSPECIFIED
Ruf, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Winter, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zengerling, FriedemannUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kliesch, SabineUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Albers, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Oing, ChristophUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-691554
DOI: 10.1007/s00345-022-03959-8
Journal or Publication Title: World J. Urol.
Volume: 40
Number: 12
Page Range: S. 2853 - 2862
Date: 2022
Publisher: SPRINGER
Place of Publication: NEW YORK
ISSN: 1433-8726
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
HIGH-DOSE CHEMOTHERAPY; LYMPH-NODE DISSECTION; CISPLATIN-BASED CHEMOTHERAPY; IFOSFAMIDE PLUS CISPLATIN; PROGNOSTIC-FACTORS; 2ND-LINE THERAPY; CARBOPLATIN; ETOPOSIDE; SEMINOMA; PACLITAXELMultiple languages
Urology & NephrologyMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/69155

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