[Rescue chemotherapy in testicular germ cell tumors]

To review the different salvage chemotherapy regimens according to the prognostic factors based on the response to the different therapeutic alternatives.

The conventional rescue chemotherapy regimens, as well as the role of surgery, new drugs and therapeutic modalities, particularly high dose second and third line chemotherapy, were reviewed.

Germ cell testicular tumor is the paradigm of curable tumors of the adult. Whereas the cure rate for stage I tumors is higher than 98%, patients with advanced stage tumors have a lower cure rate. Approximately 10% of the patients with good-prognosis factors and 30%-50% of those with poor-prognosis factors show tumor progression or recurrence after first line chemotherapy using cisplatin-based combinations. Patients who have recurrence after first line chemotherapy have a 40% probability of achieving second complete remission with second line chemotherapy, but will be sustained in only 20% of the patients, although rare cases of advanced pure seminoma that recurred have shown a cure rate of 55% with second line chemotherapy. New strategies have been developed using new drugs such as taxanes or high doses of well-known chemotherapeutic agents with autologous hematopoietic rescue that have been utilized with success in patients with refractory germ cell testicular tumors. A global analysis of the patients treated with third line chemotherapy shows a sustained complete remission rate of 22%. However, this percentage can only be increased to up to 50% for patients with no adverse factors.