Salvage Chemotherapy with Paclitaxel, Ifosfamide, and Cisplatin (TIP) in Relapsed or Cisplatin-Refractory Germ Cell Tumors

BACKGROUND: In relapsed germ cell tumors, salvage chemotherapy with paclitaxel, ifosfamide, and cisplatin (TIP) is a well-established regimen for patients with favorable features such as a primary testicular tumor and prior complete remission (CR) after the initial chemotherapy. We reviewed patients who had received salvage TIP chemotherapy, and evaluated the efficacy of TIP, linking it to patient characteristics. PATIENTS AND METHODS: Between August 1998 and May 2009, a total of 14 patients were treated with salvage TIP chemotherapy. 10 of 14 had cisplatin-refractory disease, and none of the patients were expected to show a favorable outcome to conventional-dose salvage chemotherapy. RESULTS: Of the 14 patients, 5 (37.5%) showed a favorable response (CR in 1 patient, partial response (PR) in 4 patients) to TIP alone, and 1 had CR with subsequent surgery after TIP. 2 patients with CR and another 2 patients who attained disease stabilization are still alive at 81.3, 25.4, 69.3, and 27.4 months, respectively. After a median follow-up of 41.0 months (range 11.1-137.6), the median overall survival time for all patients was 21.1 (range 5.0-112.6). CONCLUSIONS: Even in the presence of poor prognostic features, salvage TIP chemotherapy can be an active regimen in patients with relapsed or refractory germ cell tumors.