Dose-intensive therapy for germ cell neoplasms

Dose-intensive chemotherapy for recurrent or refractory germ cell cancer has evolved over the last decade. Initial experience using high-dose regimens including single agents like cyclophosphamide, thiotepa, and etoposide demonstrated that responses could be obtained in the majority of patients but that they tended to be of short duration. Second-generation studies focusing on this disease site incorporated drugs and principles specific to germ cell cancer. Large studies performed at Indiana University (Indianapolis, IN) and in several European centers have demonstrated that the addition of high-dose carboplatin or cisplatin to other regimens can result in long-term survival of otherwise incurable patients. With the results of initial pilot studies now confirmed, high-dose carboplatin-based chemotherapy is beginning to play a role in first salvage therapy, and in some centers is being used in protocols of initial therapy for poor-risk patients. Based on the success of some of the early studies in germ cell cancer, similar protocols also are being investigated for other disease sites such as ovarian cancer, neuroblastoma, lymphoma, and breast cancer.