Intensive and timely chemotherapy, the key of success in testicular cancer.
More than 90% of patients with advanced germ cell tumors (GCT) are curable since the introduction of cisplatin-based chemotherapy, but only half of them with poor-risk characteristics and less than a quarter after the first relapse are cured by conventional chemotherapy. In this review, we have studied the results of dose-intensity in conventional chemotherapy and high-dose chemotherapy (HDCT) in the treatment of GCT patients. In first line, only one randomized trial of HDCT was performed and no benefit was demonstrated. One US randomized trial is ongoing. In first salvage treatment, no randomized trial was performed, and a European trial (IT94) is ongoing. In the refractory situation, there is no indication of high-dose chemotherapy. In conclusion, high-dose chemotherapy is not a standard treatment for different situations. New strategies are needed to improve the survival rate of poor prognosis germ cell tumor patients.
Fléchon
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Department of Medical Oncology, Centre Léon Bérard, 28 rue Laennec, 69373 Lyon Cedex 08, France. droz@lyon.fnclcc.fr
Culine
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Droz
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JP
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000473:pathology / Q000628:therapy; D016879:Salvage Therapy; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000628:therapy