Salvage therapy in recurrent testicular cancer

Patients with testicular cancer who relapse after primary chemotherapy are still curable and should be treated aggressively with this goal in mind. These patients should receive a cisplatin-based regimen, usually including ifosfamide and either vinblastine or etoposide (depending upon prior exposure to drugs). As with first-line therapy, chemotherapy should not be delayed because of blood counts alone. Because this patient population has a higher incidence of significant myelosuppression, the use of hematopoietic growth factors may be of value and is currently being investigated. Patients who achieve a CR after salvage chemotherapy can be followed as usual with monthly serum markers and chest x-rays. For those patients who have a marker-negative partial remission, resection of all residual disease (if possible) is appropriate. If the surgical specimen contains only necrotic material or teratoma, then they should also be followed without further therapy. The appropriate approach for patients with residual carcinoma at the time of surgical resection is uncertain. The standard approach at Indiana University has been to give two more cycles of chemotherapy post-operatively, however most of these patients will eventually relapse and require further treatment. Patients are currently being treated with oral etoposide for 3 months after surgery in an attempt to improve long-term survival. Whether this approach will be of benefit remains to be seen. Patients who fail second-line chemotherapy should be considered for high-dose chemotherapy with autologous bone marrow rescue. Patients who do not normalize their serologic markers with first-line chemotherapy or who relapse within 1 month after chemotherapy are truly platinum refractory and do poorly with standard-dose second line cisplatin-based chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)