Systematic Review and Meta-Analysis of the Management of Relapsed Germ Cell Tumours Following Cisplatin-Based Chemotherapy.

IF 3.4 Q2 ONCOLOGY
Oncology and Therapy Pub Date : 2025-12-01 Epub Date: 2025-10-23 DOI:10.1007/s40487-025-00391-x
Nasreen Abdul Aziz, Didjier Danger Masangwi, Pinky Kotecha, Gustavo Loback, Kenrick Ng, Prabhakar Rajan, Jonathan Shamash
{"title":"Systematic Review and Meta-Analysis of the Management of Relapsed Germ Cell Tumours Following Cisplatin-Based Chemotherapy.","authors":"Nasreen Abdul Aziz, Didjier Danger Masangwi, Pinky Kotecha, Gustavo Loback, Kenrick Ng, Prabhakar Rajan, Jonathan Shamash","doi":"10.1007/s40487-025-00391-x","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Salvage treatment options after cisplatin-based chemotherapy for germ cell tumours (GCT) are either conventional-dose chemotherapy (CDCT) or high-dose chemotherapy (HDCT). However, the optimal sequencing of these strategies remains debated owing to limited comparative data guiding the choice of first-line salvage. Here, we evaluated the efficacy and safety of CDCT and HDCT, focusing on survival rates, objective response rate (ORR) and treatment-related deaths (TRD).</p><p><strong>Methods: </strong>The protocol was registered on PROSPERO (CRD42024526637). Three databases were searched and reference lists were manually screened. Two reviewers independently screened articles and extracted data, with quality and bias assessed using Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) tools. Studies of patients with metastatic GCT who relapsed after cisplatin-based chemotherapy, whether receiving first-line salvage or subsequent lines of treatment, were included in the study. In the meta-analysis, 1-, 2- and 3-year survival rates and ORR were pooled using logit transformation, back-transformed to proportions and compared between CDCT and HDCT groups.</p><p><strong>Results: </strong>Out of 2435 studies screened, 65 (5745 patients) met the inclusion criteria. Only nine studies reported International Prognostic Factor Study Group (IPFSG) scores. Median overall survival (OS) was 27 months for CDCT and 21 months for HDCT (p = 0.4035). The 1-, 2-, and 3-year survival rates were higher with CDCT (81.7%, 61.6%, 47.0%) compared with HDCT (70.0%, 57.4%, 39.1%), though not statistically significant. The pooled ORR was 53% with CDCT and 61% with HDCT. TRD were significantly lower with CDCT (3%) compared with HDCT (7.5%) (p = 0.0002). In subgroup analysis of studies evaluating second-line treatment, median OS was 23.9 months for CDCT and 19.4 months for HDCT.</p><p><strong>Conclusions: </strong>CDCT was associated with higher survival rates compared with HDCT, though the differences were not statistically significant. Larger prospective studies are needed to directly compare these strategies and guide personalised treatment selection in relapsed GCT.</p>","PeriodicalId":44205,"journal":{"name":"Oncology and Therapy","volume":" ","pages":"977-1006"},"PeriodicalIF":3.4000,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12647420/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Oncology and Therapy","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s40487-025-00391-x","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/10/23 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Introduction: Salvage treatment options after cisplatin-based chemotherapy for germ cell tumours (GCT) are either conventional-dose chemotherapy (CDCT) or high-dose chemotherapy (HDCT). However, the optimal sequencing of these strategies remains debated owing to limited comparative data guiding the choice of first-line salvage. Here, we evaluated the efficacy and safety of CDCT and HDCT, focusing on survival rates, objective response rate (ORR) and treatment-related deaths (TRD).

Methods: The protocol was registered on PROSPERO (CRD42024526637). Three databases were searched and reference lists were manually screened. Two reviewers independently screened articles and extracted data, with quality and bias assessed using Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) tools. Studies of patients with metastatic GCT who relapsed after cisplatin-based chemotherapy, whether receiving first-line salvage or subsequent lines of treatment, were included in the study. In the meta-analysis, 1-, 2- and 3-year survival rates and ORR were pooled using logit transformation, back-transformed to proportions and compared between CDCT and HDCT groups.

Results: Out of 2435 studies screened, 65 (5745 patients) met the inclusion criteria. Only nine studies reported International Prognostic Factor Study Group (IPFSG) scores. Median overall survival (OS) was 27 months for CDCT and 21 months for HDCT (p = 0.4035). The 1-, 2-, and 3-year survival rates were higher with CDCT (81.7%, 61.6%, 47.0%) compared with HDCT (70.0%, 57.4%, 39.1%), though not statistically significant. The pooled ORR was 53% with CDCT and 61% with HDCT. TRD were significantly lower with CDCT (3%) compared with HDCT (7.5%) (p = 0.0002). In subgroup analysis of studies evaluating second-line treatment, median OS was 23.9 months for CDCT and 19.4 months for HDCT.

Conclusions: CDCT was associated with higher survival rates compared with HDCT, though the differences were not statistically significant. Larger prospective studies are needed to directly compare these strategies and guide personalised treatment selection in relapsed GCT.

Abstract Image

Abstract Image

Abstract Image

以顺铂为基础的化疗后生殖细胞肿瘤复发管理的系统评价和荟萃分析。
导语:生殖细胞肿瘤(GCT)顺铂化疗后的挽救治疗选择是常规剂量化疗(CDCT)或高剂量化疗(HDCT)。然而,由于指导一线救助选择的比较数据有限,这些策略的最佳顺序仍然存在争议。在这里,我们评估了CDCT和HDCT的有效性和安全性,重点关注生存率、客观缓解率(ORR)和治疗相关死亡率(TRD)。方法:该方案在PROSPERO (CRD42024526637)上注册。检索了三个数据库,并手工筛选了参考文献列表。两位审稿人独立筛选文章和提取数据,使用非随机干预研究的偏倚风险(ROBINS-I)工具评估质量和偏倚。在以顺铂为基础的化疗后复发的转移性GCT患者的研究,无论是接受一线挽救还是后续治疗,都包括在这项研究中。在荟萃分析中,采用logit转换,将1年、2年和3年生存率和ORR合并到CDCT组和HDCT组之间,并将其反向转换为比例,进行比较。结果:在筛选的2435项研究中,有65项(5745例患者)符合纳入标准。只有9项研究报告了国际预后因素研究组(IPFSG)评分。CDCT的中位总生存期(OS)为27个月,HDCT为21个月(p = 0.4035)。CDCT的1、2、3年生存率(81.7%、61.6%、47.0%)高于HDCT(70.0%、57.4%、39.1%),但差异无统计学意义。CDCT合计ORR为53%,HDCT合计ORR为61%。CDCT的TRD(3%)明显低于HDCT (7.5%) (p = 0.0002)。在评估二线治疗的研究亚组分析中,CDCT的中位OS为23.9个月,HDCT为19.4个月。结论:与HDCT相比,CDCT与更高的生存率相关,但差异无统计学意义。需要更大规模的前瞻性研究来直接比较这些策略,并指导复发性GCT的个性化治疗选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
3.40
自引率
0.00%
发文量
31
审稿时长
6 weeks
期刊介绍: Now indexed in PubMed Aims and Scope Oncology and Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality pre-clinical, clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all therapeutic areas. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Oncology and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research. Rapid Publication The journal’s rapid publication timelines aim for a peer review decision within 2 weeks of submission. If an article is accepted it will be published online 3-4 weeks from acceptance. These rapid timelines are achieved through the combination of a dedicated in-house editorial team, who closely manage article workflow, and an extensive Editorial and Advisory Board who assist with rapid peer review. This allows the journal to support the rapid dissemination of research, whilst still providing robust peer review. Combined with the journal’s open access model this allows for the rapid and efficient communication of the latest research and reviews, allowing the advancement of clinical therapies. Personal Service The journal’s dedicated in-house editorial team offer a personal “concierge service” meaning that authors will always have a personal point of contact able to update them on the status of their manuscript. The editorial team check all manuscripts to ensure that articles conform to the most recent COPE, GPP and ICMJE publishing guidelines. This supports the publication of ethically sound and transparent research. We also encourage pre-submission enquiries and are always happy to provide a confidential assessment of manuscripts. Digital features and plain language summaries Oncology and Therapy offers a range of additional features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by key summary points, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand the scientific content and overall implications of the article. The journal also provides the option to include various types of digital features including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations. All additional features are peer reviewed to the same high standard as the article itself. If you consider that your paper would benefit from the inclusion of a digital feature, please let us know. Our editorial team are able to create high-quality slide decks and infographics in-house, and video abstracts through our partner Research Square, and would be happy to assist in any way we can. For further information about digital features, please contact the journal editor (see ‘Contact the Journal’ for email address), and see the ‘Guidelines for digital features and plain language summaries’ document under ‘Submission guidelines’. Preprints We encourage posting of preprints of primary research manuscripts on preprint servers, authors'' or institutional websites, and open communications between researchers whether on community preprint servers or preprint commenting platforms. Posting of preprints is not considered prior publication and will not jeopardize consideration in our journals. Please see here for further information on preprint sharing: https://www.springer.com/gp/authors-editors/journal-author/journal-author-helpdesk/submission/1302#c16721550 Peer Review Process Upon submission, manuscripts are assessed by the editorial team to ensure they fit within the aims and scope of the journal and are also checked for plagiarism. All suitable submissions are then subject to a comprehensive single-blind peer review. Reviewers are selected based on their relevant expertise and publication history in the subject area. The journal has an extensive pool of editorial and advisory board members who have been selected to assist with peer review based on the afore-mentioned criteria. At least two extensive reviews are required to make the editorial decision, with the exception of some article types such as Commentaries, Editorials and Letters which are generally reviewed by one member of the Editorial Board. Where reviewer recommendations are conflicted, the editorial board will be contacted for further advice and a presiding decision. Manuscripts are then either accepted, rejected or authors are required to make major or minor revisions (both reviewer comments and editorial comments may need to be addressed). Once a revised manuscript is re-submitted, it is assessed along with the responses to reviewer comments and if it has been adequately revised it will be accepted for publication. Accepted manuscripts are then copyedited and typeset by the production team before online publication. Appeals against decisions following peer review are considered on a case by case basis and should be sent to the journal editor. Copyright Oncology and Therapy''s content is published open access under the Creative Commons Attribution-Noncommercial License, which allows users to read, copy, distribute, and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited. The author assigns the exclusive right to any commercial use of the article to Springer. For more information about the Creative Commons Attribution-Noncommercial License, click here: http://creativecommons.org/licenses/by-nc/4.0 Publication Fees Upon acceptance of an article, authors will be required to pay the mandatory Rapid Service Fee of £3650/€4500/$5100. The journal will consider fee discounts for developing countries and this is decided on a case by case basis. Open Access All articles published by Oncology and Therapy are published open access Contact For more information about the journal, including pre-submission enquiries, please contact managing editor Lydia Alborn at lydia.alborn@springer.com.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信
小红书