A Phase II Study of Paclitaxel and Gemcitabine ‘Salvage’ Chemotherapy for Germ Cell Tumours that are Uncontrolled with High Dose Chemotherapy Following Tandem Transplants

A recent article published in the Journal of Clinical Oncology examined the use of a salvage chemotherapy schedule of the chemotherapy drugs, Paclitaxel and Gemcitabine in patients with progressive germ cell tumours. Patients included in the study had been previously treated with Cisplatin combination chemotherapy and high-dose chemotherapy (HDCT), and their cancer had still spread. 184 patients were treated in this manner, and only 32 of them progressed to requiring further treatment after HDCT. Of these 32, ten patients responded to therapy with Paclitaxel and Gemcitabine; six of whom displayed complete cures, lasting up to 63 months (~ 5 years). Thus, this study demonstrated a longer survival and potential cure in patients with progressive germ cell tumours, who are treated with Paclitaxel and Gemcitabine after HDCT.

Germ cell tumours respond better to chemotherapy drugs than other solid tumours, and can potentially be cured. Cisplatin combination chemotherapy is often used to treat progressive germ cell tumours, and has been successful at curing disease in 70% of cases. Within 4 weeks, the remaining 30% of cases show progression of disease. High dose chemotherapy (HDCT) has often been used as the next step of disease control to provides cures and increase patient survival. When this fails to control disease in some cases, a number of different treatments may be used. Some use Paclitaxel or Gemcitabine as single drugs, with 10-26% of patients responding to treatment. One study, however, studied the effect of using both these drugs together and found that 21% of patients responded to treatment, and 11% of these ended up disease-free. Therefore, this study used the same combination of drugs on a group of 32 patients with progressive disease after HDCT. Patients were given a mixture of the two drugs 3 days every month for 6 months. Patients were then observed for their response to the treatment over a number of years. 31% of the 32 patients responded to the treatment, and ~19% of them had complete responses, where they were disease-free for up to 3 years. One patient had a much longer disease-free survival time of greater than 5 years, but this required two separate surgical tumour removal procedures after treatment. This study found that the use of Paclitaxel and Gemcitabine in patients with germ cell tumours that had previously been treated with HDCT improved long-term disease-free survival and cure potential. More research is required to determine the best schedule of treatment with these drugs using a larger patient group.