Koychev D, Oechsle K, Bokemeyer C, Honecker F
Universitätsklinikum Hamburg-Eppendorf, Hubertus Wald Tumorcenter, Oncology, Haematology and Bone Marrow Transplantation with Section Pulmology, Hamburg, Germany.
Int J Androl. 2011 Aug;34(4 Pt 2):e266-73. doi: 10.1111/j.1365-2605.2011.01145.x.
Since the introduction of cisplatin-based therapy in the late 1970s, germ cell tumours (GCT) have been one of the successes in oncology with high cure rates even in patients presenting with metastatic disease. For patients with relapse after cisplatin-based therapy, treatment is still curative in approximately 50% of the cases. Management options for these patients include surgery, radiotherapy and use of conventional dose or high-dose chemotherapy (HDCT). Therefore, treatment of relapsed or refractory patients is complex and there is no uniformly accepted approach available. Data comparing conventional dose and HDCT in the first salvage therapy is limited to one randomized trial which was not able to ultimately define optimal treatment. More recently, a large retrospective analysis of nearly 1600 patients not only identified prognostic factors in relapse, but retrospectively suggested a 10-15% benefit regarding overall survival for patients receiving HDCT plus autologous stem cell transplantation over patients receiving conventional-dose chemotherapy. Prognosis in multiply relapsed and primary cisplatin-refractory patients is generally poor. Currently, a number of mechanisms of cisplatin resistance and potential drug targets like global methylation and BRAF mutation status are under investigation in refractory GCT.
自20世纪70年代末引入以顺铂为基础的治疗方法以来，生殖细胞肿瘤（GCT）一直是肿瘤学领域的成功案例之一，即使是患有转移性疾病的患者，治愈率也很高。对于接受以顺铂为基础治疗后复发的患者，约50%的病例治疗仍可治愈。这些患者的治疗选择包括手术、放疗以及使用常规剂量或大剂量化疗（HDCT）。因此，复发或难治性患者的治疗很复杂，且没有统一认可的可用方法。比较首次挽救治疗中常规剂量和HDCT的相关数据仅限于一项随机试验，该试验最终未能确定最佳治疗方案。最近，一项对近1600名患者的大型回顾性分析不仅确定了复发的预后因素，还通过回顾性研究表明，与接受常规剂量化疗的患者相比，接受HDCT加自体干细胞移植的患者在总生存期方面有10%至15%的获益。多次复发和原发性顺铂难治性患者的预后通常较差。目前，难治性GCT中顺铂耐药的多种机制以及潜在的药物靶点，如整体甲基化和BRAF突变状态，正在研究中。
