Part II: testicular cancer--management of advanced disease

Up to 80% of metastatic germ-cell tumours are curable with conventional chemotherapy. The combination of cisplatin, bleomycin, and etoposide has become the gold standard in this disease. Patients can be divided into good, intermediate, and poor prognosis groups. For those patients with good prognostic features, cure rates reach 90% and attempts have been made to reduce toxic effects of treatment while maintaining efficacy. Patients that relapse require salvage treatment. This can involve the incorporation of drugs such as ifosfamide and taxol into conventional protocols or the use of high-dose chemotherapy with stem-cell transplants. Patients with poor prognosis disease are much more likely to fail conventional chemotherapy and are candidates for dose-intensive protocols or transplants as first-line treatment. Although the results obtained in treating metastatic germ-cell tumours are superior to those with other solid tumour types, there are still many areas that require further improvement.