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Annals of Oncology 13:599-605, 2002
© 2002 European Society for Medical Oncology

Original Paper

High-dose versus conventional-dose chemotherapy as first-salvage treatment in patients with non-seminomatous germ-cell tumors: a matched-pair analysis

J. Beyer1,+, S. Stenning2, A. Gerl3, S. Fossa4 and W. Siegert5

1Klinik für Hämatologie und Onkologie, Klinikum der Philipps Universität, Marburg, Germany; 2Cancer Division Medical Research Council Clinical Trials Unit, Cambridge, UK; 3Medizinische Klinik III, Klinikum Grosshadern der Ludwig Maximilians Universität, München, Germany; 4Department of Medical Oncology and Radiotherapy, The Norwegian Radium Hospital, Oslo, Norway; 5Medizinische Klinik II, Humboldt Universität zu Berlin, Berlin, Germany

Received 30 May 2001; revised 1 October 2001; accepted 23 October 2001.

Background

The purpose of this study was to compare high-dose chemotherapy (HDCT) with conventional-dose chemotherapy (CDCT) as first-salvage treatment in patients with relapsed or refractory non-seminomatous germ-cell tumors (NSGCT).

Patients and methods

One hundred and ninety-three patients with relapsed or refractory NSGCT, between 1981 and 1995, were identified from two large databases. In 74 of these, intensification of first-salvage treatment by HDCT was planned. Patients were matched based on primary tumor location, response to first-line treatment, duration of this response and serum levels of the tumor markers, human chorionic gonadotrophin (HCG) and {alpha}-fetoprotein (AFP). Multivariate analyses were performed using event-free survival and overall survival as primary endpoints.

Results

Full matches on all five factors were found for 38 pairs of patients; for a further 17 pairs, matches on at least four factors could be identified. Hazard ratios in favor of HDCT were obtained between 0.72 and 0.84 [confidence interval (CI) 0.59–1.01] for event-free survival and between 0.77 and 0.83 (CI 0.60–0.99) for overall survival, depending on the type of analysis.

Conclusions

The current analysis suggests a benefit from HDCT, with an estimated absolute improvement in event-free survival of between 6 and 12% and in overall survival of between 9 and 11% at 2 years. This benefit is lower than expected from previous phase I/II studies.

Key words: hematopoietic stem cell transplantation, matched-pair analysis, non-seminoma, prognosis, salvage therapy, seminoma


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