McNeish I A, Kanfer E J, Haynes R, Giles C, Harland S J, Driver D, Rustin G J S, Newlands E S, Seckl M J
Department of Medical Oncology, Imperial College School of Medicine, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
Br J Cancer. 2004 Mar 22;90(6):1169-75. doi: 10.1038/sj.bjc.6601664.
High-dose regimes containing etoposide, carboplatin and an oxazaphospharine can salvage 30-40% of patients with relapsed or refractory male germ cell tumours (GCTs). The additional benefit of paclitaxel in such high-dose therapy has not been tested. Between March 1995 and November 2002, 36 male GCT patients were treated with Carbop-EC-T (paclitaxel 75 mg x m(-2), etoposide 450 mg x m(-2), carboplatin AUC 10 on days -7, -5 and -3 and cyclophosphamide 60 mg x kg(-1) on days -5 and -3) followed by peripheral blood stem cell infusion (day 0). The 1-year overall survival rate for all patients is 67% (median follow-up 29 months). For the 24 patients with cisplatin-sensitive disease, the 1-year overall and event-free survivals are 88 and 64%, respectively. For those with cisplatin refractory or absolutely refractory disease, the 1-year overall survival is 25%. In all, 12 patients relapsed at a median duration of 5 months, 11 of whom have died. There were also six treatment-related deaths, five associated with pneumonitis. Pulmonary toxicity has been reported with paclitaxel in other high-dose regimes. Since altering our protocol so that paclitaxel is infused over 24 h with steroid prophylaxis, only one of 18 patients (13 testicular GCTs and five other tumour types) has had a treatment-related death. Our results suggest that Carbop-EC-T may enable a greater proportion of patients with relapsed and refractory GCTs to enter long-term remission.
含依托泊苷、卡铂和一种氮杂磷类药物的大剂量方案可挽救30%至40%复发或难治性男性生殖细胞肿瘤（GCT）患者。紫杉醇在这种大剂量治疗中的额外益处尚未得到验证。1995年3月至2002年11月，36例男性GCT患者接受了Carbop-EC-T方案治疗（第-7、-5和-3天给予紫杉醇75mg×m⁻²、依托泊苷450mg×m⁻²、卡铂AUC 10，第-5和-3天给予环磷酰胺60mg×kg⁻¹），随后进行外周血干细胞输注（第0天）。所有患者的1年总生存率为67%（中位随访29个月）。对于24例对顺铂敏感的患者，1年总生存率和无事件生存率分别为88%和64%。对于顺铂难治或绝对难治的患者，1年总生存率为25%。共有12例患者在中位时间5个月时复发，其中11例死亡。还有6例与治疗相关的死亡，5例与肺炎有关。在其他大剂量方案中，紫杉醇也有肺部毒性的报道。自从改变我们的方案，使紫杉醇在24小时内输注并给予类固醇预防后，18例患者（13例睾丸GCT和5例其他肿瘤类型）中只有1例出现与治疗相关的死亡。我们的结果表明，Carbop-EC-T方案可能使更大比例的复发和难治性GCT患者实现长期缓解。
