title: The management of poor-prognosis, non-seminomatous germ-cell tumours.
abstract: Despite a high cure rate in men with testicular cancer, some men in the poor-prognosis group have a less favourable outcome. Poor-prognosis non-seminomatous germ-cell tumours (NSGCT) are defined as those with high tumour markers, non-pulmonary visceral metastases or a mediastinal primary site at presentation. When treated with standard chemotherapy regimens, such as bleomycin, etoposide and cisplatin (BEP), cure rates of less than 50% have been achieved in an international pooled analysis. Some strategies aimed at improving results include the use of multi-agent regimens (e.g. POMB/ACE), intensive-induction chemotherapy (e.g. CBOP/BEP), new chemotherapy drugs, such as ifosfamide, gemcitabine, oxaliplatin, paclitaxel, high-dose chemotherapy, including autotransplantation. To date, no schedule has been proven to be better than standard BEP in randomised trials. We will review the published data relating to first-line and salvage treatment of poor-prognosis NSGCT. To advance the management of this disease, physicians treating poor-prognosis disease are urged to support multi-centre trials, such as the recently launched MRC TE23 study comparing BEP and CBOP/BEP.
authors.affiliation: The Academic Unit of Radiotherapy and Oncology, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, Surrey, UK.
authors.forename: B
authors.initials: B
authors.lastname: Sirohi
authors.forename: R
authors.initials: R
authors.lastname: Huddart
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D006801:Humans; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000473:pathology*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D016879:Salvage Therapy; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000473:pathology*