Chemotherapy for advanced germ cell tumors Journal Article

Authors: Kondagunta, G. V.; Motzer, R. J.
Article Title: Chemotherapy for advanced germ cell tumors
Abstract: Purpose: Germ cell tumors constitute the most curable of all cancers. Standard treatment of previously untreated and treated patients has evolved on the basis of prospective clinical trials and prognostic factors. This review summarizes the prognostic criteria on which treatment decisions may be based, and outlines the current treatment approaches. Patients and Methods: Randomized and nonrandomized trials of first-line, salvage, and palliative therapy and the role of surgery after chemotherapy were reviewed. In the treatment of previously untreated patients, emphasis was placed on interpretation of data of trials according to the International Germ Cell Cancer Collaborative Group model, which has evolved into a universally accepted classification algorithm for determining appropriate risk-directed chemotherapy. This system permits treatment choices based on the balance between benefit and toxicity and allows comparison of results across multiple clinical trials. Results: Standard therapy for good-risk patients is four cycles of etoposide plus cisplatin or three cycles of cisplatin, etoposide plus bleomycin (BEP x 3); both approaches cure approximately 90% of patients. After chemotherapy and normalization of markers, patients should generally undergo resection of residual masses. Approximately 75% of intermediate-risk and 45% of poor-risk patients group achieve a durable complete response with BEP x 4. Potentially curative options in the salvage setting include ifosfamide plus cisplatin-containing standard dose therapy and high-dose carboplatin plus stem-cell rescue. Surgery remains an essential component of care. Conclusion: Curative therapy exists even in patients with resistant disease, and treatment choices can be based on established clinical criteria. Serum tumor markers and surgery after chemotherapy have essential roles in patient management. © 2006 by American Society of Clinical Oncology.
Keywords: clinical article; controlled study; human tissue; cancer surgery; clinical trial; histopathology; review; salvage therapy; cisplatin; paclitaxel; drug megadose; antineoplastic agent; neoplasm; palliative care; carboplatin; controlled clinical trial; multiple cycle treatment; etoposide; randomized controlled trial; antineoplastic combined chemotherapy protocols; palliative therapy; continuous infusion; ifosfamide; risk assessment; algorithm; randomized controlled trials; bleomycin; bep protocol; neoplasms, germ cell and embryonal; germ cell tumor; seminoma
Journal Title: Journal of Clinical Oncology
Volume: 24
Issue: 35
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2006-12-10
Start Page: 5493
End Page: 5502
Language: English
DOI: 10.1200/jco.2006.08.7882
PUBMED: 17158534
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 26" - "Export Date: 4 June 2012" - "CODEN: JCOND" - "Source: Scopus"
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MSK Authors
  1. Robert Motzer
    1033 Motzer