title: Salvage chemotherapy after failure of first-line chemotherapy in patients with metastatic testicular cancer.
abstract: OBJECTIVE
  Because of the small number of relapsed patients, their prognostic variability and the complexity of second-line therapy, randomized studies are largely lacking and treatment recommendations for patients with relapse after first-line chemotherapy are derived from retrospective series or phase II studies. This review summarizes the existing evidence including several recently published larger studies on the use of high-dose chemotherapy in these patients.
  
  
  RESULTS
  Patients with unfavorable features such as incomplete response to first-line therapy, cisplatin refractoriness, multiple relapses or advanced stage at initial diagnosis have been shown to benefit from salvage high-dose chemotherapy with autologous stem cell support. Long-term survival rates of up to 60% have been reported after salvage high-dose chemotherapy for these patients. The treatment for patients relapsing after complete remission to first-line therapy, cisplatin-sensitive disease and gonadal primary remains controversial. Excellent long-term event-free survival rates of up to 80% have been reported after both conventional and high-dose chemotherapy. Surgery remains an important part of any salvage strategy.
  
  
  CONCLUSIONS
  The prognosis of patients relapsing after first-line cisplatin-based chemotherapy has improved with multimodality therapy including conventional and high-dose chemotherapy, surgery and radiation. The treatment of these patients requires a close cooperation of experienced medical oncologists, urologists and radiation oncologists.
authors.affiliation: Division of Medical Oncology, British Columbia Cancer Agency, University of British Columbia- Vancouver Cancer Centre, Vancouver, British Columbia, Canada. ckollmannsberger@bccancer.bc.ca
authors.forename: Christian
authors.initials: C
authors.lastname: Kollmannsberger
authors.forename: Carsten
authors.initials: C
authors.lastname: Bokemeyer
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D002986:Clinical Trials as Topic; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008297:Male; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology*; D017239:Paclitaxel / Q000008:administration & dosage; D036102:Peripheral Blood Stem Cell Transplantation; D011379:Prognosis; D013736:Testicular Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D013997:Time Factors; D017211:Treatment Failure; D013519:Urogenital Surgical Procedures; D014747:Vinblastine / Q000008:administration & dosage
chemical_list: D014747:Vinblastine; D017239:Paclitaxel; D002945:Cisplatin; D007069:Ifosfamide