# High-dose chemotherapy in male germ cell cancer patients—a study by the SWENOTECA group

## TL;DR

This study evaluates the effectiveness and safety of high-dose chemotherapy in treating male germ cell cancer patients under the SWENOTECA guidelines.

## Contribution

The study provides survival and toxicity data for high-dose chemotherapy in germ cell cancer patients following harmonized SWENOTECA guidelines.

## Key findings

- Patients with delayed tumor-marker decline had a 75% 5-year overall survival rate with no toxic deaths.
- High-dose chemotherapy was feasible and associated with promising survival outcomes.
- Grade 3–4 infections were common, affecting 86% of patients.

## Abstract

World-wide consensus is lacking regarding patient selection and timing of high-dose chemotherapy (HDCT) with autologous stem-cell support in males with germ cell cancer (GCC). However, within the Swedish and Norwegian Testicular Cancer Group (SWENOTECA) guidelines are harmonised. Our aim was to evaluate survival and toxicity in HDCT-treated GCC-patients within SWENOTECA.

In total, 7322 GCC patients were diagnosed between 2011–2021 in Sweden and Norway, among which 80 ( ~ 1.1%) patients were treated with HDCT. Indications for HDCT were: Delayed tumour-marker decline during primary/intensified primary treatment (n = 45), progressive disease (n = 29), or relapse (n = 25). The HDCT-regimen consisted of two cycles of carboplatin/etoposide.

The 5-year overall survival (5-yr OS) and progression-free survival (5-yr PFS) after HDCT was 55% and 43%, respectively. Indication delayed tumour-marker decline: 5-yr OS:75%, 5-yr PFS:53%, indication progressive disease 5-yr OS:29%, 5-yr PFS:18%, indication relapse 5-yr OS:61%, 5-yr PFS:58%. Four (5%) died due to HDCT-related complications, none within the delayed tumour-marker decline group. Grade 3–4 infections were seen in n = 69, 86%.

HDCT-treatment according to the SWENOTECA-programme was feasible and associated with promising OS. Early intensification to HDCT for patients with delayed tumour-marker decline during primary-treatment was safe and led to 5-yr OS of 75% with no toxic deaths.