Germ cell tumors: dose-intensive therapy

Dose intensive chemotherapy in germ cell tumor patients has become a relatively safe procedure after the introduction of growth factors and the availability of autologous stem cells for hematopoietic rescue. Carboplatin and etoposide are the most active drugs available today, and are given in one or two subsequent cycles at dosages between 1000 and 2000 mg/m2 and 1200 and 2400 mg/m2, respectively. The potency of this approach is shown by the induction of long-term disease-free survival in a small proportion of patients with multiply relapsed or far advanced disease, deemed incurable with conventional chemotherapy. This observation indicates that cisplatin refractoriness can be overcome by high-dose carboplatin and etoposide. High-dose treatment (HDT) instituted earlier in the course of the disease, ie, for first-line salvage or even in first-line treatment of poor risk patients is better tolerated and is hoped to lead to superior tumor eradication. The value of HDT needs to be determined in randomized studies, some of which are under way.