Bokemeyer C, Harstrick A, Rüther U, Metzner B, Illiger H J, Clemm C, Siegert W, Link H, Ostermann H, Schmoll H J
Department of Hematology/Oncology, Hannover University Medical School, Germany.
Semin Oncol. 1994 Dec;21(6 Suppl 16):57-63.
Hematopoietic growth factors, such as granulocyte-macrophage colony-stimulating factor (GM-CSF), may gain increasing importance in the treatment of patients with malignant germ cell tumors. For patients with far advanced testicular cancer, who only have a chance of long-term cure in the range of 40% to 50% by standard induction chemotherapy, the German Testicular Cancer Study Group has shown that the application of GM-CSF after PEI chemotherapy has allowed the increase of dose intensity of this three-drug regimen by a factor of 1.4. In 75 evaluable patients an overall survival rate of 79% after a median follow-up of 27 months was achieved. The dose-limiting toxicity of this stepwise dose escalation protocol of the PEI regimen was severe mucositis/enteritis (World Health Organization [WHO] degrees 3/degrees 4) in 33% of the patients and prolonged thrombocytopenia (< 20,000/microL for more than 10 days). In future trials, hematopoietic growth factors will be used in the treatment of far-advanced testicular cancer to generate peripheral blood stem cells (PBSC) that can be used to overcome both granulocytopenia and thrombocytopenia. This approach with the use of PBSC and hematopoietic growth factors will allow us to apply multiple cycles of up-front dose-intensified PEI chemotherapy in this unfavorable subgroup of patients. However, with the establishment of an optimal hematopoietic support in these studies, the value of dose-intensified chemotherapy in advanced testicular cancer will have to be tested against standard dose regimens in prospective randomized trials.
造血生长因子，如粒细胞-巨噬细胞集落刺激因子（GM-CSF），在恶性生殖细胞肿瘤患者的治疗中可能会变得越来越重要。对于晚期睾丸癌患者，标准诱导化疗的长期治愈率仅在40%至50%之间，德国睾丸癌研究组表明，在PEI化疗后应用GM-CSF可使这种三联药物方案的剂量强度提高1.4倍。在75例可评估患者中，中位随访27个月后总生存率达到79%。PEI方案这种逐步增加剂量方案的剂量限制性毒性是33%的患者出现严重的粘膜炎/肠炎（世界卫生组织[WHO]3级/4级）以及长期血小板减少（<20,000/μL超过10天）。在未来的试验中，造血生长因子将用于治疗晚期睾丸癌，以生成可用于克服粒细胞减少和血小板减少的外周血干细胞（PBSC）。这种使用PBSC和造血生长因子的方法将使我们能够在这个预后不良的患者亚组中应用多个周期的前期剂量强化PEI化疗。然而，随着这些研究中最佳造血支持的建立，晚期睾丸癌中剂量强化化疗的价值将必须在前瞻性随机试验中与标准剂量方案进行对比测试。
