Treatment of germ cell tumors – update 2006

Abstract

Testicular cancer is considered a malignancy with a high cure rate even in patients with metastatic disease. Treatment strategies are based on the extent of the disease and prognostic factors and require cooperation of medical specialists such as medical oncologists, radiation oncologists and urologic surgeons. Today, cure rates of 95–99% for patients with early stage testicular cancer and 50–90% for patients with widely metastatic disease are achievable. While there are different treatment options for early stage disease, cisplatin-based combination chemotherapy with or without resection of residual masses remains the therapeutic mainstay for patients with metastatic disease. Three or four cycles of BEP (Bleomycin, Etoposide, Cisplatin) are given for patients with either a good and intermediate or a poor prognosis according to the International Germ Cell Consensus Classification Group (IGCCCG) classification, respectively [1]. Four cycles of EP (etoposide, cisplatin) are an acceptable alternative to three cycles of BEP for good prognosis patients [2, 3]. Due to these excellent treatment results, testicular cancer research in recent years has mainly focused on two areas: on the one hand on minimizing toxicity while maintaining efficacy and evaluation of treatment-related long-term toxicity and on the other hand on the evaluation of new therapeutic options for patients with poor prognosis and cisplatin resistance. This also involves experimental work on the mechanisms of chemotherapy response and resistance in this disease. This review will focus on the most relevant findings provided in these fields within the most recent years.