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Current chemotherapeutic approaches for recurrent or refractory germ cell tumors

Brent O'Carrigan1, Peter Grimison1

  • 1Department of Medical Oncology, Chris O׳Brien Lifehouse, Camperdown, New South Wales, Australia; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.

Urologic Oncology
|October 14, 2014
PubMed
Abstract

Insights

Salvage chemotherapy offers durable remissions for 20-30% of patients with relapsed or refractory germ cell tumors (GCT) after initial treatment fails. This review covers conventional dose chemotherapy (CDCT) regimens used in these challenging GCT cases.

Area of Science:

  • Medical Oncology
  • Clinical Research
  • Cancer Therapeutics

Background:

  • Metastatic testicular germ cell tumors (GCT) present a challenge, with up to 25% of patients not achieving cure after first-line therapy.
  • Relapsed or refractory GCT necessitates effective salvage treatment strategies.

Purpose of the Study:

  • To review the evidence for commonly used conventional dose chemotherapy (CDCT) salvage regimens in patients with relapsed or refractory GCT.
  • To discuss other active chemotherapy combinations and single-agent salvage options.
  • To address the management of growing teratoma syndrome and malignant transformation of teratoma.

Main Methods:

  • A comprehensive literature search was performed across major databases (PubMed, Medline, Cochrane, EMBASE) from 1950 to 2014.
  • Relevant review articles and conference proceedings were hand-searched for additional references.
  • The focus was on clinical trials of chemotherapy for relapsed or refractory GCT.

Main Results:

  • Conventional dose chemotherapy (CDCT) regimens can achieve durable remissions in 20-30% of patients undergoing first or subsequent salvage therapy.
  • Specific CDCT regimens like TIP, VIP, and VeIP, based on ifosfamide and cisplatin, are highlighted.

Conclusions:

  • Salvage CDCT, including ifosfamide and cisplatin-based regimens, provides a viable option for a subset of patients with refractory or relapsed GCT.
  • The review provides a foundation for understanding current salvage strategies, with companion articles exploring high-dose chemotherapy and novel agents.
Keywords:
ChemotherapyGerm cell tumorSalvage therapyTesticular cancer

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