[Salvage therapy for refractory testicular cancer]

Cisplatin-based conventional chemotherapy followed by surgery can cure 80-70% of disseminated testicular cancers. Effective salvage therapy is required for the remaining 20-30% of patients. High-dose chemotherapy (HDCT) combined with autologous stem-cell rescue for refractory testicular tumor results in about 10-20% durable complete responses. Hematologic toxicity is severe, and about 10% treatment-related deaths were reported in early investigations. Early salvage therapy or first-line therapy using HDCT is under investigation to improve treatment efficacy of the refractory or poor-risk testicular cancer. One of the important findings of these trials is that a platinum analogue may be critical to HDCT for cisplatin-refractory cases. Recent basic research has showed that platinum-containing anticancer drug provokes a complex response in the cancer cells. It is hoped that investigation of the mechanism of cisplatin-resistance or development of a new platinum complex will overcome the limitations of salvage chemotherapy for this disease. Finally, several investigators reported that highly selected chemorefractory patients, even with positive tumor markers, have definite potential for cure with surgical resection of localized metastatic disease. Thus, salvage surgery may be indicated for patients refractory to all potentially curative chemotherapeutic regimens.