title: High-dose chemotherapy plus stem cell transplantation in advanced germ cell cancer: a review.
abstract: BACKGROUND
  High-dose chemotherapy (HDCT) with stem cell transplantation (SCT) has been investigated as a treatment strategy for advanced germ cell cancer (GCC) for >2 decades. In an effort to improve on the overall cure rates of 80% achievable with conventional chemotherapy, researchers have investigated this therapeutic option as a first-line therapy for those with poor-prognosis disease and as a salvage therapy for those with relapsed or refractory disease.
  
  
  OBJECTIVE
  The primary objective of this review is to define the role of HDCT plus SCT in advanced GCC. Prognostic indicators for this group of patients are also presented.
  
  
  METHODS
  A Medline search of English-language literature was performed to identify studies published in the last 20 yr relating to the use of HDCT plus SCT in advanced GCC. Phase 1, phase 2, and phase 3 trials were included, as were retrospective reviews and meta-analyses.
  
  
  RESULTS
  Phase 2 trials investigating HDCT plus SCT as a therapeutic option for advanced germ cell cancer have indicated a survival advantage over conventional chemotherapy. This has not been confirmed in the phase 3 setting. Alternative chemotherapeutic strategies and options following failure of HDCT plus SCT are discussed.
  
  
  CONCLUSIONS
  Studies to date have not indicated a survival advantage for the use of HDCT plus SCT in advanced germ cell cancer. Many questions, however, remain unanswered, and further research is required to identify whether optimising the strategy of HDCT plus SCT will improve outcome in this predominantly young group of patients.
authors.affiliation: Sidney Kimmel Comprehensive Cancer Centre, Johns Hopkins School of Medicine, 1650 Orleans Street, CRB 1, Room 186, Baltimore, MD 21231-1000, USA. rconnol2@jhmi.edu
authors.forename: Roisin M
authors.initials: RM
authors.lastname: Connolly
authors.forename: John A
authors.initials: JA
authors.lastname: McCaffrey
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D006801:Humans; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000556:secondary / Q000628:therapy*; D011379:Prognosis; D016879:Salvage Therapy / Q000379:methods; D033581:Stem Cell Transplantation; D013736:Testicular Neoplasms / Q000628:therapy*; D017211:Treatment Failure