Salvage treatment: the role of highdose chemotherapy.

1
Salvage treatment the role of high-dose
chemotherapy.

• Jean-Pierre Droz, MD.
• Department of Medical Oncology
• Centre Léon-Bérard.
• Claude-Bernard, Lyon-1 University.
• Lyon, France.

ESMO International Symposium, München 15-16 may
2008.
2
Overall...

• In the salvage setting overall 30-50 of patients
  are cured.
• Overall the good-prognostic factors are
• Prior CR status (Time to relapse?).
• Testis or retroperitoneal primaries.
• Cisplatin sensitive disease.
• Good-risk charateristics patients 40-60 are
  cured.
• Poor-risk characteristics patients 10-30 are
  cured.

3
European consensus.
4
Summary of the largest trials.
5
No impact of consolidation HDCT.
Not selected, but not cisplatin-refractory
patients 4 VeIP versus 3 VeIP hd CEC.
6
Not selected patients Sequential
versus Consolidation HDCT.
7
Overall survival by treatment
No impact on overall survival of either treatment
schedules.
8
Overall survival according to Motzer
No impact in good-risk group? Impact in poor-risk
group?
Motzer et al. J Clin Oncol 2000,182413
9
Summary of the largest trials.
10
The majority of patients had good-risk
characteristics.
This series is not conclusive.
11
184 not selected patients.
This series is not conclusive.
12
This series is in favor of an impact of
sequential HDCT.
Patients with -extragonadal primary. -Incomplete
response. -cisplatin refractory disease.
13
Conclusion 1.

• Overall, there is no impact of HDCT.
• HDCT may have an impact in poor-risk group
  patients.
• A trial in this poor-risk group of patients seems
  desirable.
• But, in the practice dont forget...

14
The importance of the complete exeresis of
residual disease after HDCT.
15
Role of salvage surgery after HDCT failure.
Salvage surgery may be the only effective
salvage treatment after HDCT failure.
16
NCCN recommendations.
17
Conclusion 2.

• Poor-risk patients at salvage have
• Mediastinum primary.
• IR disease.
• Cisplatin refractory disease.
• Poor-risk patients are those who may benefit of
  HDCT it remains to be demonstrated.
• Surgery is still a good salvage treatment, even
  after HDCT failure.