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SYSTEMATIC REVIEW article
Front. Oncol.
Sec. Genitourinary Oncology
Volume 14 - 2024 |
doi: 10.3389/fonc.2024.1437574
High-dose chemotherapy as ini3al salvage chemotherapy in pa3ents with relapsed or refractory tes3cular cancer: a systema3c review and meta-analysis
Provisionally accepted- 1 Pontificia Universidad Católica de Chile, Santiago, Santiago Metropolitan Region (RM), Chile
- 2 University of Oxford, Oxford, England, United Kingdom
The role of high-dose chemotherapy followed by autologous hematopoie-c cell transplanta-on in the management of pa-ents with relapsed/refractory germ-cell tumours has not been established in prospec-ve studies. The aim is to es-mate the benefits and harms of this treatment in men with relapsed/refractory germ-cell tumours.Electronic databases, conference proceedings, and trial registers un-l 30 April 2023.Randomized and non-randomized prospec-ve controlled trials were included. Risk of bias assessments were performed using either RoB2 or ROBINS-I tools. Certainty of evidence was assessed with the GRADE approach.Time-to-event data was analyzed using hazard ra-o. The primary outcome was overall survival, and a metaanalysis was not conducted to assess it because non-randomized trials were judged to have a cri-cal risk of bias.Categorical data were analyzed using risk ra-o.All results are presented with the corresponding 95% confidence interval.Four out of 3824 records met the inclusion criteria, and three out of four were used to assess primary and secondary outcomes. Based on the IT94 study (N=263 par-cipants), single high-dose chemotherapy followed by autologous hematopoie-c cell transplanta-on may have li_le to no effect on overall survival (HR 0.98, 95%CI 0.68 to 1.42; p=0.916). Non-randomized trials (N=43 par-cipants) showed contras-ng results, which may be explained by the number of cycles of high-dose chemotherapy administered in each study.Regarding secondary outcomes, informa-on was only provided for event-free survival, response rate and acute toxici-es.Based on prospec-ve data, there is insufficient evidence to support or refute the proposal that high-dose chemotherapy with autologous hematopoie-c cell transplanta-on improves survival in males with relapsed/refractory germ-cell tumours. If this treatment is considered essen-al, the choice should be made by experienced clinicians at high-volume cancer centers.
Keywords: Refractory germ cell tumors, high dose chemotherapy with autologous stem cell transplantation, chemotherapy, relapsed germ cell tumor, Survival, Adverse (side) effects
Received: 24 May 2024; Accepted: 26 Aug 2024.
Copyright: © 2024 Briones, Diaz and Nicholson. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Juan Briones, Pontificia Universidad Católica de Chile, Santiago, 3580000, Santiago Metropolitan Region (RM), Chile
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