High-dose chemotherapy followed by stem cell transplant (HDCT) is potentially curative for patients with refractory germ cell tumors (rGCT). There is scarce real-world data supporting its implementation in low- and middle-income countries. We described the experience of our tertiary cancer center in Sao Paulo, Brazil.
We identified male patients ≥18 years-old with rGCT referred to HDCT after board discussion. Clinical data, including delays in HDCT protocol, were extracted from medical records, and survival outcomes were estimated using the Kaplan-Meier method. The log-rank test and Cox proportional hazard were used to determine effects on overall survival (OS).
From January 2013 to January 2023, 34 patients were referred and considered eligible to receive 2 cycles of HDCT. Most patients had primary testicular tumors (82%), nonseminomatous histology (88%), and poor International Germ Cell Collaborative Group (IGCCCG) (79%). Twenty-three patients received HDCT (1 cycle, n = 8; 2 cycles, n = 15). Main reasons for not receiving any HDCT were death due to progressive disease (n = 1), performance deterioration (n = 7), and failure of stem cell mobilization (n = 3). OS at 2 years was 36.7% for the eligible population, 56.1% for patients who underwent at least 1 HDCT, and 77.1% for those who had ≥2 cycles. The 2-year OS rate for patients not given HDCT was 0%. All patients had delays in protocol, and poor-risk patients had longer intervals from referral to protocol initiation (0.7 vs. 1.8 month, P < .01).
Outcomes of patients who received ≥1 HDCT were encouraging; however, only 15 from 34 eligible patients were able to receive the planned 2 cycles of HDCT. Further strategies to minimize treatment delays in low- and middle-income countries are needed.
Clinical genitourinary cancer. 2024 Mar 24 [Epub ahead of print]
Gabriel Berlingieri Polho, Mateus Trinconi Cunha, Maiana Hamdan Melo Coelho, Jamile Almeida-Silva, Cassio Murilo Hidalgo Filho, Erick Menezes Xavier, Nathalia de Souza Crusoe, Marcelo Junqueira Atanazio, Vitor Fiorin de Vasconcellos, Vivian Naomi Horita, Guilherme Fialho Freitas, David Queiroz Muniz, Vanderson Rocha, Jose Mauricio Mota
Genitourinary Medical Oncology Service, Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil., Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Unit of Cell Therapy of Hematology/Cell therapy Department, Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo (USP), Sao Paulo, SP, Brazil., Genitourinary Medical Oncology Service, Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Hospital Universitario Cassiano Antonio de Moraes, Universidade Federal do Espirito Santo, Espírito Santo, Brazil., Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Unit of Cell Therapy of Hematology/Cell therapy Department, Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo (USP), Sao Paulo, SP, Brazil; Instituto DOr de Pesquisa e Ensino, Espírito Santo, Brazil., Genitourinary Medical Oncology Service, Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Instituto DOr de Pesquisa e Ensino, Espírito Santo, Brazil. Electronic address: .