Tandem High-Dose Chemotherapy With Autologous Stem Cell Rescue for Poor-Prognosis Germ Cell Cancer

Fecha de inicio: 1 de febrero de 1997

DISEASE CHARACTERISTICS: Evaluable germ cell cancer (measurable by radiographic study and/or serum tumor marker elevation) and not curable by standard salvage therapy OR viable cancer on resection of post-chemotherapy residual masses in either intermediate or high risk category Bidimensionally measurable disease with measurements performed within 21 days of study entry Tumor marker (alpha-fetoprotein, lactate dehydrogenase, beta-human chorionic gonadotropin) studies performed within 7 days prior to study entry PATIENT CHARACTERISTICS: Age: 16 and over Performance status: Karnofsky 70-100% Life expectancy: Not specified Hematopoietic: Absolute neutrophil count at least 1,500/mm^3 Platelet count at least 120,000/mm^3 Hemoglobin at least 10 g/dL Hepatic: Bilirubin no greater than 1.6 mg/dL SGOT and SGPT no greater than 2 times upper limit of normal (ULN) No active hepatitis or cirrhosis Renal: Creatinine clearance at least 70 mL/min Cardiovascular: Ejection fraction (MUGA or echocardiogram) normal No EKG evidence of active cardiac disease (arrhythmias, ischemia) which would contraindicate etoposide and paclitaxel study treatment Pulmonary: PaO_2 at least 70 mm Hg FEV_1 at least 2 L or 75% No history of bleomycin associated or serious lung disease Neurologic: No steroid or glucocorticoid treatment for patients with CNS metastatic disease; at least 1 month with stable post-radiotherapy neurological status and seizure free; if prior seizures, at least 1 month with therapeutic anticonvulsant levels prior to study Prior peripheral neuropathy requires consultation with principal investigator Other: No significant active medical illness precluding study or survival Not HIV positive No prior malignancy within past 5 years except for adequately treated basal cell or squamous cell skin cancer No prior hematologic malignancies PRIOR CONCURRENT THERAPY: Biologic therapy: No prior bone marrow or stem cell rescue with high-dose chemotherapy Chemotherapy: Prior chemotherapy allowed, excluding high-dose therapy with bone marrow or stem cell rescue No prior paclitaxel Endocrine therapy: Not specified Radiotherapy: No concurrent radiotherapy during study Surgery: Recovered from prior surgery