Antitumor activity of paclitaxel after failure of high-dose chemotherapy in a patient with late relapse of a non-seminomatous germ cell tumor.

Although cisplatin-based chemotherapy considerably improved the clinical outcome of patients with metastatic germ cell tumors, approximately 20% of patients fail to achieve a durable remission to first-line treatment and require effective salvage treatment. As only 20-30% of patients can expect disease-free long-term survival after conventional salvage treatment, an increasing proportion of patients has been referred to high-dose chemotherapy with autologous stem cell rescue during recent years. However, high-dose chemotherapy still fails to cure a considerable number of patients, emphasizing the need to continue the search for new active drugs. We report here the case of a patient with late relapse of a non-seminomatous germ cell tumor who failed to respond to high-dose chemotherapy after heavy pretreatment with 11 cycles of cisplatin-based chemotherapy. The patient received paciltaxel for symptomatic disease with hepatic and pulmonary metastases, and attained a partial remission. Despite the heavy pretreatment, hematologic toxicity of paciltaxel was tolerable. As recent reports described responses to single-agent paciltaxel in a quarter of pretreated patients with germ cell tumors, further clinical trials seem justified to study the role of paciltaxel in combination regimens against this cancer type.