On 2013 Jun 18, Martin Fenner commented:

This study reports the long-term results of a trial first published in 2007 Lorch A, 2007, confirming that in patients with relapsed or refractory germ cell tumors overall survival and progression-free survival after sequential high-dose chemotherapy are comparable to single high-dose chemotherapy, but with fewer early deaths.

This paper is important because it not only shows a high cure rate with high-dose chemotherapy for patients with relapsed or refractory germ cell tumors, but also because it is one of the few successful prospective randomized trials of high-dose chemotherapy in this patient population. Two randomized trials looking at first-line high-dose chemotherapy in IGCCCG poor risk patients (Motzer RJ, 2007 and PMCID: PMC3082158) were underpowered because of recruitment problems, leading to the inclusion of IGCCCG intermediate risk patients (a patient group with very different prognosis) in Motzer RJ, 2007 and premature trial closure in PMCID: PMC3082158.

Prospective randomized trials continue to be a challenge in patients with relapsed/refractory testicular cancer and in patients in the IGCCCG poor prognosis group for a variety of reasons (small number of patients, lack of funding for conventional chemotherapy, good existing treatment options), but are critically important.

On 2013 Jun 18, Martin Fenner commented:

This study reports the long-term results of a trial first published in 2007 Lorch A, 2007, confirming that in patients with relapsed or refractory germ cell tumors overall survival and progression-free survival after sequential high-dose chemotherapy are comparable to single high-dose chemotherapy, but with fewer early deaths.

This paper is important because it not only shows a high cure rate with high-dose chemotherapy for patients with relapsed or refractory germ cell tumors, but also because it is one of the few successful prospective randomized trials of high-dose chemotherapy in this patient population. Two randomized trials looking at first-line high-dose chemotherapy in IGCCCG poor risk patients (Motzer RJ, 2007 and PMCID: PMC3082158) were underpowered because of recruitment problems, leading to the inclusion of IGCCCG intermediate risk patients (a patient group with very different prognosis) in Motzer RJ, 2007 and premature trial closure in PMCID: PMC3082158.

Prospective randomized trials continue to be a challenge in patients with relapsed/refractory testicular cancer and in patients in the IGCCCG poor prognosis group for a variety of reasons (small number of patients, lack of funding for conventional chemotherapy, good existing treatment options), but are critically important.