Salvage Therapy for Relapsed/Refractory Testicular Germ Cell Tumors: King Faisal Hospital and Research Center, Riyadh Experience

Purpose: Optimal salvage treatment for relapsed/refractory germ cell tumors in men remains controversial. The options include conventional-dose chemotherapy (CDCT) and high-dose chemotherapy with autologous stem cell transplantation (HDCT-ASCT). There is currently a lack of data from the Middle East on this topic. This study presents the largest single-institution experience in the region. Methods: We retrospectively examined patients aged 14 years or older, treated at King Faisal Hospital and Research Center, Riyadh, between 2010 and 2022. Patients previously received first-line, cisplatin-based chemotherapy. The treatment consisted of either CDCT or HDCT-ASCT. The primary endpoints were event-free survival (EFS) and overall survival (OS). Results: Study included 46 patients, of whom 24 and 22 received CDCT and HDCT-ASCT, respectively. Using the IPFSG prognostic model as per local institutional practice, patients in the very low, low, and intermediate risk groups received CDCT. In the 24-patient CDCT group, 16 (66%) were high/very high risk, and only 2 (8%) demonstrated primary refractoriness. Contrarily, of the 22 patients who received HDCT-ASCT, 20 (91%) were classified as high/very high risk, and 17 (77%) were primary refractory to first-line treatment. The HDCT-ASCT cohort was heavily weighted toward high/very high risk. HDCT-ASCT group (59%) had a higher complete remission rate than the CDCT group (59% vs 41%). With a median follow-up of 35 months, the 3-year OS was 60% in the CDCT group and 53% in the HDCT-ASCT group, whereas the 3-year EFS rates were 54% and 43%, respectively. Discussion: Results indicated that HDCT-ASCT achieved a superior response rate compared with CDCT, despite an adverse prognostic profile and numerically comparable survival outcomes with the lower-risk cohort treated with CDCT. These findings suggest that the selection of higher-risk patients for a more intensive therapy is an effective strategy. However, direct comparison is limited by the retrospective nature.