Table 3. Salvage high-dose chemotherapy for children with extragonadal germ-cell tumour.
| No. | T. to first Rel/PD (mo) | Second-line standard-dose chemotherapy before HDC (response) | T. to second Rel/PD (mo) | HDC setting (no. Rel) | Induction regimen (response) | Status before HDC | Sites of disease before HDC | HDC regimen (no. cycles) | Response | Further therapies (response) | DFS (mo) | OS (mo) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 4 | None | NA | 1st Rel | Carbop, Vbl, Bl, Vcr, AcD, Adr, Cy(CR) | CR | NED | CarboPEC (1) | CR | Surg, CT, RT (CR) | 21 | 173+ |
| 2 | 10 | None | NA | 1st Rel | None | SR | Liver, B | PEC (1), CE (1) | CR | None | 77+ | 77+ |
| 3 | NA | None | NA | 1st Rel | None | PD | CNS | TE (1) | PT | RT-CNS (Unk) | 0 | 12 |
| 4 | 11 | Cis, VP16, Ifo, RT-CNS (CR) | 19 | 2nd Rel | None | SR | CNS | CE (1) | CR | RT-CNS (Adj) | 73+ | 73+ |
| 5 | 9 | None | NA | 1st Rel | CT (PR–), STRR (CR) | CR | NED | CarboPEC (1) | CR | None | 73+ | 73+ |
| 6 | 7 | Cis, VP16, Ifo (PR–) | 14 | 2nd Rel | Ifo, Adm (PR–) | PR– | Unk | TE (1) | PR− | RRRD (CR) | 68+ | 68+ |
| 7 | 4 | Carbopl, VP16, RT-CNS (SD) | 2 | 2nd Rel | None | SD | CNS | HD-Cyc (2) | PD | CT (PD) | 0 | 3 |
| 8 | 16 | None | NA | 1st Rel | Cis, Vcr, Ifo (CR) | CR | NED | CarboPETM (1) | CR | Unk (Unk) | Unk | 51 |
| 9 | 7 | Carbop, Vcr, AcD, Adr (PR+) | 8 | 2nd Rel | None | PR+ | Sacr, Retr, Liver | CarboPTC (1) | PD | None | 0 | 5 |
| 10 | 5 | None | NA | 1st Rel | None | SR | CNS | CM (1) | CR | None | 66+ | 66+ |
| 11 | 2 | None | NA | 1st Rel | VP16, Ifo (PR-), MTRR (CR) | CR | NED | TE (1) | CR | None | 63+ | 63+ |
| 12 | 1 | Cis, Vcr, Bl, VP16, Ifo (PD) | NA | 2nd Rel | None | PD | Med, CNS, Lung, B | CarboPEC (1) | PD | None | 0 | 3 |
| 13 | 2 | Cis, VP16, Bl (PR−) | 8 | 2nd Rel | RT-CNS, Cis, VP16, Ifo (PT) | PT | CNS | CarboPEC (1) | PT | Surg (CNS) | 0 | 16 |
| 14 | 62 | Cis, BCNU, VP16, Cy (PR−) | 6 | 2nd Rel | None | SR | CNS | CM (1) | CR | RT-CNS, CT (PD) | 5 | 5 |
| 15 | 9 | Cis, VP16, Ifo (CR) | 9 | 2nd Rel | None | SR | Unk | TE (1) | CR | None | 63+ | 63+ |
| 16 | 4 | Ifo, VP16, Vcr, AcD, Cy (CR) | 41 | 2nd Rel | Carbopl, VP16, Ifo, Cy (CR) | CR | NED | CarboPETM (1) | CR | Unk (PD) | Unk | 29 |
| 17 | 18 | Carbop, VP16, Ifo, Cis, Vbl (PD) | NA | 2nd Rel | None | PD | CNS | TE (1) | CR | None | 40+ | 40+ |
| 18 | 8 | Cis, VP16, Vcr (PR+) | 6 | 2nd Rel | Carbop, Vbl, Bl (PT) | PT | Lung | CarboPEC (1) | CR | RT-Lung | 9 | 11 |
| 19 | 1 | Cis, VP16, Bl, Ifo (PR+) | 3 | 2nd Rel | None | PR+ | CNS | CarboPEC (2) | CR | RT-CNS, CT (PD) | 6 | 8 |
| 20 | 9 | None | NA | 1st Rel | None | SR | Unk | ICE (1), TC (1) | PD | CT, Surg (PD) | 0 | 15 |
| 21 | 3 | Cis, Vcr, Mtx, Bl, AcD, Cy (PR+) | 6*(5**) | 3rd Rel | None | PR+ | Retr | CE (3) | PR− | RRRD (CR) | 34+ | 34+ |
| 22 | 26 | None | NA | 1st Rel | Carbop, VP16, Ifo (CR) | CR | NED | TM (1) | CR | None | 31+ | 31+ |
| 23 | 10 | Cis, VP16, Bl (PR+) | 8 | 2nd Rel | None | PR+ | Retr | Unk (1) | PR+ | None | 0 | 5 |
*After 6 months second Rel, treated with third-line standard-dose chemotherapy with Ifo,Vbl, VP16 (PR+); **after 5 months 3rd Rel/PD.
Abbreviations: T.to first or second Rel/PD, Time to first or second relapse/progressive disease; HDC, high-dose chemotherapy; mo, months; NA, not applicable; Sacr, sacrococcix; CNS, central nervous system; Retr, retroperitoneum; Med, mediastinum; B, bone; NED, not evidence of disease; Unk, unknown; IT, immature teratoma; MT, mature teratoma; YST, yolk sac tumour; EC, embryonal carcinoma; Germ, germinoma; CC, choriocarcinoma; AFP, alpha-fetoprotein (ng ml−1); HCG, human choriogonadotropin (IU l−1); MTRR, mediastinal tumour radical resection; STRR, sacrococcigeal tumour radical resection; RRRD, radical resection of residual disease; Cis, cisplatin; Vbl, vinblastin; Bl, bleomycin; VP16, etoposide; Ifo, ifosfamide; ActD, actinomycin D; Cy, cyclophosphamide; Carbop, carboplatin; Vcr, vincristine; BCNU, bendamustine; Mtx, methotrexate; Adm, adriamycin; CT, chemotherapy (schedule/drugs not available); RT, radiotherapy; Adj, adjuvant; CR, complete remission; PR−, marker-negative partial remission; PR+, marker-positive partial remission; SD, stable disease; PD, progressive disease; PT, persistent tumour with response not evaluable; SR, sensitive relapse (indicating patients relapsing after a previous CR or PR− and receiving frontline HDC without induction regimens). For abbreviations of HDC regimens, see Table 2.