Management of progressive brain metastases in patients (pts) with relapsed germ-cell tumor (GCT) treated with salvage high-dose chemotherapy (HDCT).

5036 Background: Previous data confirm that pts with relapsed GCT and progressive brain metastases (mets) can be cured with HDCT and peripheral blood stem cell transplantation (PBSCT) 1 . Still, there is uncertainty with the optimal management sequence of these pts prior to transplant. Here, we describe the management and outcomes of a larger cohort of these pts. Methods: The prospectively maintained Indiana University testicular cancer database was queried for pts with relapsed metastatic GCT who were to undergo HDCT with PBSCT and were noted to have progressive brain mets at time of relapse. Baseline characteristics were summarized. The Kaplan-Meier method was used to analyze progression free survival (PFS) and overall survival (OS). Results: 49 pts met eligibility. Median age was 28.7yrs (16.6-51.5). Primary site was testis in 44 (90.0%), mediastinal in 4 (8.2%), and retroperitoneum in 1 (2.0%). All patients had nonseminomatous disease. Primary tumor predominant histology was choriocarcinoma (34.7%), embryonal (32.7%), mixed (18.4%), teratoma (6.1%), yolk sac tumor (4.1%), and seminoma (2.0%). IGCCCG risk at diagnosis was poor in 91.8%, intermediate in 2.1%, and good in 6.1%. 24 pts (49%) were platinum refractory at HDCT. 17 pts (34.7%) had brain mets at diagnosis; the rest developed at relapse. The table lists pt characteristics. 26 pts (53.1%) went straight to HDCT without localized treatment to progressive brain mets. 8 (16.3%) underwent craniotomy and 8 (16.3%) had radiation prior to HDCT. 3 of the pts who had radiation had stereotactic radiosurgery (SRS); 5 had whole brain radiotherapy (WBRT). 7 pts (14.3%) underwent craniotomy then radiation prior to HDCT. 5 pts (15.2%) were symptomatic from progressing brain mets at HDCT. 1 of these had mild visual symptoms and went straight to HDCT. 1 pt began having headaches the day before HDCT and given proximity to initiation, HDCT was continued. The other 3 symptomatic pts had previously failed localized treatment for brain mets. 22 pts (44.9%) progressed after HDCT. At a median follow-up of 3.8 yrs (0.6-14.8), 16 pts (32.7%) were alive with no evidence of disease, 10 (20.4%) were alive with disease, 20 (40.8%) died of disease, and 3 (6.1%) died of other causes. 2-yr PFS was 43.9%; 2-yr OS was 73.2%. Conclusions: Pts with relapsed GCT with progressive brain mets can be cured with HDCT with PBSCT. Management of progressive brain mets should be individualized for each pt, taking into account extent of brain mets and presence of symptoms. Reference: 1. Kalra M, et al. Cancer.2020; 126(6): 1202-1207.Table: see text