title: The contemporary role of chemotherapy for advanced testis cancer: a systematic review of the literature.
abstract: BACKGROUND
  Germ cell tumours (GCTs) of the testis are the most common cancer in young men; they are also one of the most curable cancers. Standard treatment of metastatic GCTs has evolved on the basis of randomised trials and prognostic factors.
  
  
  OBJECTIVE
  This review summarises the evolving role of chemotherapy in the treatment of previously treated and untreated patients with metastatic GCTs and outlines the current standard treatment.
  
  
  METHODS
  Randomised and nonrandomised trials of first-line, salvage, and palliative therapy were reviewed.
  
  
  RESULTS
  Three cycles of standard bleomycin, etoposide, and platinum (BEP) can be considered the gold-standard treatment in good-risk patients, and four cycles of the same combination can result in cure in approximately 80% of intermediate-risk and 50% of poor-risk patients. The routine use of high-dose chemotherapy in patients with intermediate- or poor-prognosis GCT has not improved treatment outcome, but the role of tumour marker decline during the first cycles may provide useful prognostic information. Prognostic variables in patients who experience treatment failure after cisplatin-based chemotherapy can be used to guide salvage strategies, and many new drugs or combinations have shown activity in this setting. Patients and physicians should be aware of the risk of short- and long-term toxicity of treatments, and guidelines for screening and prevention of this risk should be established.
  
  
  CONCLUSIONS
  A risk-based strategy offers the best chance of cure, even in patients with refractory GCT.
authors.affiliation: Department of Medical Oncology, San Camillo Forlanini Hospital, Rome, Italy. fabiocalabro1@alice.it
authors.forename: Fabio
authors.initials: F
authors.lastname: Calabrò
authors.forename: Peter
authors.initials: P
authors.lastname: Albers
authors.forename: Carsten
authors.initials: C
authors.lastname: Bokemeyer
authors.forename: Chris
authors.initials: C
authors.lastname: Martin
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Einhorn
authors.forename: Alan
authors.initials: A
authors.lastname: Horwich
authors.forename: Susanne
authors.initials: S
authors.lastname: Krege
authors.forename: Hans Joachim
authors.initials: HJ
authors.lastname: Schmoll
authors.forename: Cora N
authors.initials: CN
authors.lastname: Sternberg
authors.forename: Gedske
authors.initials: G
authors.lastname: Daugaard
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D018572:Disease-Free Survival; D019317:Evidence-Based Medicine; D006801:Humans; D008297:Male; D009361:Neoplasm Invasiveness; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D010166:Palliative Care; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D016879:Salvage Therapy; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D013997:Time Factors; D017211:Treatment Failure