Salvage treatment for testicular cancer with standard-or high-dose chemotherapy; a systematic review of 59 studies

Relapsed germ cell tumor (GCT) is a highly curable cancer with standard-dose platinum-based chemotherapy (CT); however, high-dose CT (HDCT) is seldom used as salvage therapy instead or after conventional CT. We conducted a systematic review of published trials to compare outcomes between standard-dose CT and HDCT in patients with relapsed GCT after first-line therapy for advanced disease. A literature search was carried out in multiple electronic databases (PubMed, Embase, Scopus, Web of Science, and The Cochrane Library), and studies reporting salvage treatment of relapsed GCT with standard-dose or carboplatin-etoposide-based HDCT were selected. Overall response rate, median overall survival (OS), and the 1-, 2-, 3-, and 5-year OS rates were pooled, and the significance of difference between arms was assessed with a Chi-square test. Twenty-nine standard-dose and 31 HD studies were included in the meta-analysis. For standard-dose CT versus HDCT, there was no significant difference in median OS (14.8 months and 24.09 months, respectively; P = 0.09) or in 1-, 2-, 3-, or 5-year survival rate (standard-dose CT, 64.2, 63.6, 45.1, and 43%, respectively; HDCT, 63.7, 51.2, 46.7, and 45%, respectively; P = 0.9, P = 0.4, P = 0.75, and P = 0.06). Conventional dose regimens and HDCT were associated with comparable efficacy when used as salvage therapies in relapsed GCTs as second-line therapy or beyond. However, the selection of ideal candidates for more or less intensive treatments deserves further research in the near future.