Chemotherapy of male and female germ cell tumors

Germ cell tumors of testicular origin are virtually always curable with modern therapy that appropriately integrates chemotherapy and surgery. Clinical trials of chemotherapy in patients with disseminated disease now separate those with limited metastatic disease and an excellent prognosis from those with bulky tumor and a less favorable prognosis. In the former group, it has been shown that three courses of BEP (bleomycin/etoposide/cisplatin) are therapeutically comparable to four courses. The next generation study compared BEP with a similar regimen with the bleomycin omitted. Early results of this study suggest that deletion of bleomycin worsens outcome. Other studies have addressed the same question but have used four courses of this agent. Ovarian germ cell tumors have been less well studied but are largely curable with surgery and chemotherapy. The specific regimens used are similar to their testis tumor counterparts. All patients with completely resected tumor should receive adjuvant chemotherapy; virtually all will remain cancer free. Of course, patients with advanced disease should also receive chemotherapy. Results are generally good in these patients, but probably less so than in testis tumor patients with similar tumor volume.