Future trials in germ cell malignancy (GCM) of the testis

With overall cure in excess of 95%, there is a debate about how to conduct further trials. Three areas are reviewed: (1) Relapse and high risk patients. With a plethora of new drugs and high dose salvaging one in three second-line failures, there is plenty of choice. Substituting taxol for etoposide in etoposide, ifosfamide and cisplatin (VIP), followed by high dose, is one possibility. (2) For low-risk metastatic disease the current priority is to recruit large numbers to the EORTC/MRC three vs four courses bleomycin, etoposide and cisplatin (BEP) and 3 vs 5 day etoposide trial to evaluate the safety of risking less toxic treatment. (3) For stage 1 disease, non-seminoma, quality of life assessments and evaluating patient participation in decisions about adjuvant therapy are the principal priorities. For seminoma one course carboplatin, the first realistic alternative to radiotherapy, is currently being tested in a MRC trial. During the next decade there will be two areas of interest in addition to those above. Firstly, trials of testis conservation to reduce the use of orchidectomy on diagnosis. For advanced drug-resistant disease, gene therapy using candidate genes found to be responsible for a chemotherapy response, and exploration of their role within non-germ cell cancer.