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

Inclusion Criteria

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