First-line chemotherapy of disseminated germ cell tumors

The development of effective chemotherapy has been the defining event in the history of testicular cancer treatment. The discovery of cisplatin-based chemotherapy created a massive inflection that sharply defined the relatively grim precisplatin era from the astonishing postcisplatin era. The ripple effects of this discovery continue today with the rewriting of management of early-stage germ cell tumors to surveillance-based programs. This article reviews the discovery, development, and delivery of cisplatin-based chemotherapy; expected outcomes of chemotherapy treatment; remaining controversies in primary chemotherapy treatment of disseminated disease; and practical management tips for delivery of bleomycin, etoposide, and cisplatin and after chemotherapy treatment.