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Poor-risk germ cell tumors. Recent developments

P M Dodd1, R J Motzer, D F Bajorin

  • 1Department of Medical Oncology-Hematology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.

The Urologic Clinics of North America
|September 5, 1998
PubMed
Summary
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Standard chemotherapy for poor-risk germ cell tumors, bleomycin, etoposide, and cisplatin (BEP), cures about half of patients. High-dose chemotherapy with stem cell transplantation is being investigated as a potentially more effective initial therapy.

Area of Science:

  • Oncology
  • Hematology

Background:

  • Standard therapy for poor-risk germ cell tumors involves four cycles of bleomycin, etoposide, and cisplatin (BEP) chemotherapy.
  • BEP chemotherapy cures approximately 50% of patients with poor-risk germ cell tumors.
  • Randomized trials have not identified a conventional-dose chemotherapy regimen superior to BEP.

Purpose of the Study:

  • To evaluate the efficacy of high-dose chemotherapy with stem cell or autologous bone marrow transplantation as initial therapy for poor-risk germ cell tumors.
  • To compare high-dose chemotherapy approaches with standard BEP therapy.

Main Methods:

  • Two randomized trials were conducted to assess high-dose chemotherapy with stem cell or autologous bone marrow transplantation.
  • The International Germ Cell Consensus Classification was used for uniform risk assignment and decision making.

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Main Results:

  • Preliminary data suggest potential efficacy for high-dose chemotherapy in initial treatment.
  • Further results from the randomized trials are pending.

Conclusions:

  • High-dose chemotherapy with stem cell transplantation is an emerging area of investigation for poor-risk germ cell tumors.
  • Standardized risk classification is crucial for clinical trials and decision-making.