title: Pharmacotherapeutic treatment of germ cell tumors: standard of care and recent developments.
abstract: BACKGROUND
  Testicular germ cell tumors are the most common malignancy among men aged 40 and less. Since the introduction of cisplatin-based combination chemotherapy, germ cell tumors are among the most curable solid tumors with cure rates of 95% in all patients and > 80% in metastatic disease.
  
  
  METHODS
  Current standards and future developments in GCT treatment, including adjuvant chemotherapy, first line treatment for metastatic disease, and salvage regimens in case of relapse and refractory disease.
  
  
  CONCLUSIONS
  Maintaining therapeutic success while further reducing treatment-related toxicity is paramount. Cancer-specific survival in localized disease approximates 100%. Therefore, orchidectomy followed by active surveillance is the preferred approach for all seminomas and non-seminomas lacking lymphovascular invasion. Non-seminomas with lymphovascular invasion should be offered adjuvant treatment with one cycle of bleomycin, etoposide and cisplatin (BEP). The BEP regimen remains standard of care for metastatic disease, while the role of primary high-dose chemotherapy in case of inadequate tumor-marker decline or presence of high-risk features (i.e. mediastinal origin, non-pulmonary visceral metastases) remains to be elucidated. Several curative salvage chemotherapy combinations are available, i.e. TIP, VeIP, GIP or high-dose carboplatin and etoposide. GOP is the current option of choice in cisplatin-refractory patients. Novel targeted agents failed to improve treatment outcome so far.
authors.affiliation: a Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology , University Medical Center Eppendorf , Hamburg , Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Oing
authors.affiliation: a Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology , University Medical Center Eppendorf , Hamburg , Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Seidel
authors.affiliation: a Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology , University Medical Center Eppendorf , Hamburg , Germany.
authors.forename: Gunhild
authors.initials: G
authors.lastname: von Amsberg
authors.affiliation: a Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology , University Medical Center Eppendorf , Hamburg , Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Oechsle
authors.affiliation: a Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology , University Medical Center Eppendorf , Hamburg , Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Bokemeyer
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D006801:Humans; D058990:Molecular Targeted Therapy; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000473:pathology; D016879:Salvage Therapy; D059039:Standard of Care; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000473:pathology
chemical_list: D016190:Carboplatin
keywords: Testicular cancer; chemotherapy; cisplatin-refractory disease; germ cell tumor; high-dose chemotherapy; salvage treatment