Multicenter analysis of high-dose chemotherapy regimens for the treatment of patients with refractory or recurrent germ cell tumors.
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BACKGROUND: High-dose chemotherapy (HDCT) is an established salvage treatment for recurrent germ cell tumors (GCTs). Comparative analyses of contemporary carboplatin-based HDCT regimens are limited. This study provides a multicenter analysis of commonly used regimens. PATIENTS AND METHODS: Data from four referral centers included patients treated with HDCT for recurrent GCTs between January 2010 and January 2024. Fisher's exact test and the Wilcoxon rank sum test were used for statistical analyses. Kaplan-Meier and log-rank tests assessed relapse-free survival (RFS) and overall survival (OS). RESULTS: Among 111 patients (median age 28.5 years), 76.6% had non-seminomatous GCT, and 43.2% had poor-risk disease per the International Germ Cell Cancer Collaborative Group (IGCCCG) classification. HDCT regimens included CE (50 patients; carboplatin and etoposide for two cycles) and TICE (32 patients; paclitaxel and ifosfamide, followed by carboplatin and etoposide for three cycles). HDCT was second-line in 26.1% and third-line or beyond in 73.9%. After 55.5 months' follow-up, no significant difference in RFS was observed [10.2 versus 5.9 months; hazard ratio (HR) 0.91, 95% confidence interval (CI) 0.54-1.51, P = 0.706]. TICE showed a trend toward longer OS (57.2 versus 19.8 months; HR 0.67, 95% CI 0.37-1.2, P = 0.18) and significantly improved OS in IGCCCG intermediate-/poor-risk patients (57.2 versus 14.0 months; HR 0.44, 95% CI 0.2-0.99, P = 0.047). CONCLUSIONS: No significant difference in RFS or OS was observed between CE and TICE overall. However, TICE may offer more benefit to patients with higher-risk disease. Prospective studies are needed to validate these findings.