What Is the Optimal Salvage Therapy for Patients with Relapsed Germ-Cell Tumors?

A substantial number of patients with advanced germ-cell tumors who relapse within 2 years of initial cisplatin-based chemotherapy can be rendered long-term survivors either with salvage chemotherapy (various cisplatin-based triplet regimens) or with high-dose chemotherapy — typically carboplatin plus etoposide with stem-cell rescue. Despite this demonstrated utility, the settings in which high-dose chemotherapy can be applied optimally remain unclear.

In two earlier prospective trials of high-dose chemotherapy — one as initial therapy in patients with poor-risk disease (Journal Watch Hematology and Oncology Feb 5 2007) and one as initial salvage therapy (Ann Oncol 2005; 16:1152) — researchers failed to demonstrate improvements in outcomes c…