[Treatment of metastatic testicular carcinoma according to prognosis; new development]

The majority of patients with a metastatic germ cell tumour can be successfully treated with a combination chemotherapy containing cisplatin. For more than a decade the combination of cisplatin, etoposide and bleomycin (BEP) has been the gold standard of treatment. In both the United States and Europe, a number of studies have been carried out, with the purpose of reducing the toxicity of the treatment for patients with a good prognosis as well as improving the treatment result for patients with intermediate or unfavourable prognostic characteristics, by intensifying the chemotherapy regimen or by adding new cytotoxic agents. The standard treatment for patients with a good prognosis consists at present of three BEP cycles, which can be administered in a shortened schedule of three days per cycle. Bleomycin is essential for the success of the therapy and cisplatin cannot be replaced by carboplatin. Efforts to increase the dose of cisplatin per cycle, reduce the interval between cycles, the addition of ifosfamide and sequential/alternating therapy do not provide any additional benefit compared to the standard treatment with BEP.