Current pharmacotherapy for testicular germ cell cancer. (3rd May 2019)

• Record Type: Journal Article
• Authors: Alsdorf, Winfried; Seidel, Christoph; Bokemeyer, Carsten; Oing, Christoph
• Is Part Of: Expert opinion on pharmacotherapy. Volume 20:Number 7(2019)
• Page Start: 837
• Page End: 850
• Publication Date: 2019-05-03
• Subjects: Active surveillance -- cisplatin -- platinum-based chemotherapy -- tumor marker decline -- high-dose chemotherapy; Chemotherapy -- Periodicals; 615.5805
• DOI: 10.1080/14656566.2019.1583745
• Languages: English
• ISSNs: 1465-6566

Abstract

ABSTRACT: Introduction : With the implementation of platinum-based chemotherapy, germ cell tumors (GCTs) became a model for a curable solid tumor, with survival rates of 95% in all patients with >80% survival in metastatic stages. Areas covered : Herein, the authors review the current standards of adjuvant chemotherapy for stage I GCTs as well as first-line and salvage treatments for metastatic disease. Novel approaches for refractory disease are also reviewed. Expert opinion : Active surveillance should be considered for all stage I patients and is the preferred approach for stage I seminoma. In stage I non-seminomas with vascular invasion, one cycle of bleomycin, etoposide, and cisplatin (BEP) substantially reduces the relapse risk. For most advanced GCTs, BEP remains the first-line standard of care. For poor prognosis disease treatment, stratification according to tumor marker decline is recommended. The role of primary high-dose chemotherapy (HDCT) for selected very high-risk patients remains to be prospectively evaluated. Salvage HDCT at relapse seems superior to conventional chemotherapy, retrospectively. The treatment of multiply relapsed disease remains challenging. The gemcitabine/oxaliplatin/paclitaxel (GOP) protocol is considered the standard for refractory disease. However, overall, outcomes are poor and new treatment approaches are urgently needed with targeted therapies so far failing to yield relevant clinical activity.