Skip to main content
SpringerLink
Log in

Chemotherapy for Testicular Cancer

  • Chapter
  • First Online:
Urological Oncology

  • 1622 Accesses

Abstract

The management of testicular cancer has evolved over the last three decades. The importance of staging and prognostic group assessments at all points in disease management has allowed reduction in treatment exposure for patients with good outcomes including the increased use of surveillance for stage 1 disease. Combination cisplatin and etoposide- based therapy remains the cornerstone of management of metastatic disease. The likelihood of success can be predicted for an individual based on tumor marker levels and sites of metastases. Patients with very advanced disease at presentation remain a challenge as chemotherapy often needs to be modified. The quality of response to this initial therapy itself predicts for success with further therapy should relapse occur. High dose chemotherapy with autologous stem cell support is of value in chemo-sensitive second relapse although its use earlier in the disease remains controversial. Surgery to sites of metastatic disease remains an important component of curative therapy. Finally attention to long term side effects has become of increasing importance and has led to increased efforts to reduce unnecessary treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Einhorn LH, Donohue J. Cis-diamminedichloroplatinum, vinblastine, and bleomycin combination chemotherapy in disseminated testicular cancer. Ann Intern Med. 1977;87(3):293–8.

    Article  CAS  PubMed  Google Scholar 

  2. Fitzharris BM, Kaye SB, Saverymuttu S, et al. VP16-213 as a single agent in advanced testicular tumors. Eur J Cancer. 1980;16(9):1193–7.

    Article  CAS  PubMed  Google Scholar 

  3. Williams SD, Birch R, Einhorn LH, et al. Treatment of disseminated germ-cell tumors with cisplatin, bleomycin, and either vinblastine or etoposide. N Engl J Med. 1987;316(23):1435–40.

    Article  CAS  PubMed  Google Scholar 

  4. Toner GC, Stockler MR, Boyer MJ, et al. Comparison of two standard chemotherapy regimens for good-prognosis germ-cell tumours: a randomised trial. Australian and New Zealand Germ Cell Trial Group. Lancet. 2001;357(9258):739–45.

    Article  CAS  PubMed  Google Scholar 

  5. de Wit R, Stoter G, Kaye SB, et al. Importance of bleomycin in combination chemotherapy for good-prognosis testicular nonseminoma: a randomized study of the European Organization for Research and Treatment of Cancer Genitourinary Tract Cancer Cooperative Group. J Clin Oncol. 1997;15(5):1837–43.

    PubMed  Google Scholar 

  6. Kondagunta GV, Bacik J, Bajorin D, et al. Etoposide and cisplatin chemotherapy for metastatic good-risk germ cell tumors. J Clin Oncol. 2005;23(36):9290–4.

    Article  CAS  PubMed  Google Scholar 

  7. Einhorn LH, Williams SD, Troner M, Birch R, Greco FA. The role of maintenance therapy in disseminated testicular cancer. West J Med. 1983;138(5):708.

    Google Scholar 

  8. Horwich A, Sleijfer DT, Fossa SD, et al. Randomized trial of bleomycin, etoposide, and cisplatin compared with bleomycin, etoposide, and carboplatin in good-prognosis metastatic nonseminomatous germ cell cancer: a Multi institutional Medical Research Council/European Organization for Research and Treatment of Cancer Trial. J Clin Oncol. 1997;15(5):1844–52.

    CAS  PubMed  Google Scholar 

  9. Oldenburg J, Kraggerud SM, Cvancarova M, et al. Cisplatin-induced long-term hearing impairment is associated with specific glutathione s-transferase genotypes in testicular cancer survivors. J Clin Oncol. 2007;25(6):708–14.

    Article  CAS  PubMed  Google Scholar 

  10. Sagstuen H, Aass N, Fossa SD, et al. Blood pressure and body mass index in long-term survivors of testicular cancer. J Clin Oncol. 2005;23(22):4980–90.

    Article  CAS  PubMed  Google Scholar 

  11. de Wit R, Stoter G, Sleijfer DT, et al. Four cycles of BEP vs four cycles of VIP in patients with intermediate-prognosis metastatic testicular non-seminoma: a randomized study of the EORTC Genitourinary Tract Cancer Cooperative Group. European Organization for Research and Treatment of Cancer. Br J Cancer. 1998;78(6):828–32.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Flechon A, Biron P, Droz JP. High-dose chemotherapy with hematopoietic stem-cell support in germ-cell tumor patient treatment: the French experience. Int J Cancer. 1999;83(6):844–7.

    Article  CAS  PubMed  Google Scholar 

  13. Rick O, Bokemeyer C, Beyer J, et al. Salvage treatment with paclitaxel, ifosfamide, and cisplatin plus high-dose carboplatin, etoposide, and thiotepa followed by autologous stem-cell rescue in patients with relapsed or refractory germ cell cancer. J Clin Oncol. 2001;19(1):81–8.

    CAS  PubMed  Google Scholar 

  14. Rodenhuis S, de Wit R, de Mulder PH, et al. A multi-center prospective phase II study of high-dose chemotherapy in germ-cell cancer patients relapsing from complete remission. Ann Oncol. 1999;10(12):1467–73.

    Article  CAS  PubMed  Google Scholar 

  15. Shamash J, Powles T, Mutsvangwa K, et al. A phase II study using a topoisomerase I-based approach in patients with multiply relapsed germ-cell tumours. Ann Oncol. 2007;18(5):925–30.

    Article  CAS  PubMed  Google Scholar 

  16. Loehrer Sr PJ, Gonin R, Nichols CR, et al. Vinblastine plus ifosfamide plus cisplatin as initial salvage therapy in recurrent germ cell tumor. J Clin Oncol. 1998;16(7):2500–4.

    CAS  PubMed  Google Scholar 

  17. Sandler AB, Cristou A, Fox S, et al. A phase II trial of paclitaxel in refractory germ cell tumors. Cancer. 1998;82(7):1381–6.

    Article  CAS  PubMed  Google Scholar 

  18. Bower M, Newlands ES, Holden L, et al. Treatment of men with metastatic non-seminomatous germ cell tumours with cyclical POMB/ACE chemotherapy. Ann Oncol. 1997;8(5):477–83.

    Article  CAS  PubMed  Google Scholar 

  19. Einhorn LH, Stender MJ, Williams SD. Phase II trial of gemcitabine in refractory germ cell tumors. J Clin Oncol. 1999;17(2):509–11.

    CAS  PubMed  Google Scholar 

  20. Hinton S, Catalano P, Einhorn LH, et al. Phase II study of paclitaxel plus gemcitabine in refractory germ cell tumors (E9897): a trial of the Eastern Cooperative Oncology Group. J Clin Oncol. 2002;20(7):1859–63.

    Article  CAS  PubMed  Google Scholar 

  21. Einhorn LH, Brames MJ, Juliar B, Williams SD. Phase II study of paclitaxel plus gemcitabine salvage chemotherapy for germ cell tumors after progression following high-dose chemotherapy with tandem transplant. J Clin Oncol. 2007;25(5):513–6.

    Article  CAS  PubMed  Google Scholar 

  22. Bokemeyer C, Oechsle K, Honecker F, et al. Combination chemotherapy with gemcitabine, oxaliplatin, and paclitaxel in patients with cisplatin-refractory or multiply relapsed germ-cell tumors: a study of the German Testicular Cancer Study Group. Ann Oncol. 2008;19(3):448–53.

    Article  CAS  PubMed  Google Scholar 

  23. Pectasides D, Pectasides M, Farmakis D, et al. Oxaliplatin and irinotecan plus granulocyte-colony stimulating factor as third-line treatment in relapsed or cisplatin-refractory germ-cell tumor patients: a phase II study. Eur Urol. 2004;46(2):216–21.

    Article  CAS  PubMed  Google Scholar 

  24. Shamash J, Powles T, Ansell W, et al. GAMEC–a new intensive protocol for untreated poor prognosis and relapsed or refractory germ cell tumours. Br J Cancer. 2007;97(3):308–14.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Cullen M, Steven N, Billingham L, et al. Antibacterial prophylaxis after chemotherapy for solid tumors and lymphomas. N Engl J Med. 2005;353(10):988–98.

    Article  CAS  PubMed  Google Scholar 

  26. Powles TB, Bhardwa J, Shamash J, et al. The changing presentation of germ cell tumours of the testis between 1983 and 2002. BJUI. 2005;95(9):1197–200.

    Article  Google Scholar 

  27. Warde P, Specht L, Horwich A, et al. Prognostic factors for relapse in stage I seminoma managed by surveillance: a pooled analysis. J Clin Oncol. 2002;20(22):4448–52.

    Article  PubMed  Google Scholar 

  28. Aparicio J, Maroto P, del Muro XG, et al. Risk-adapted treatment in clinical stage I testicular seminoma: the third Spanish Germ Cell Cancer Group study. J Clin Oncol. 2010;29(35):4677–81.

    Article  Google Scholar 

  29. Oliver RT, Mead GM, Rustin GJ, et al. Randomized trial of carboplatin versus radiotherapy for stage I seminoma: mature results on relapse and contralateral testis cancer rates in MRC TE19/EORTC 30982 study (ISRCTN27163214). J Clin Oncol. 2010;29(8):957–62.

    Article  Google Scholar 

  30. Cullen MH, Stenning SP, Parkinson MC, et al. Short-course adjuvant chemotherapy in high-risk stage I nonseminomatous germ cell tumors of the testis: a Medical Research Council report. J Clin Oncol. 1996;14(4):1106–13.

    CAS  PubMed  Google Scholar 

  31. Albers P, Siener R, Krege S, et al. Randomized phase III trial comparing retroperitoneal lymph node dissection with one course of bleomycin and etoposide plus cisplatin chemotherapy in the adjuvant treatment of clinical stage I Nonseminomatous testicular germ cell tumors: AUO trial AH 01/94 by the German Testicular Cancer Study Group. J Clin Oncol. 2008;26(18):2966–72.

    Article  CAS  PubMed  Google Scholar 

  32. International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers. International Germ Cell Cancer Collaborative Group. J Clin Oncol. 1997;15(2):594–603.

    Google Scholar 

  33. Fossa SD, de Wit R, Roberts JT, et al. Quality of life in good prognosis patients with metastatic germ cell cancer: a prospective study of the European Organization for Research and Treatment of Cancer Genitourinary Group/Medical Research Council Testicular Cancer Study Group (30941/TE20). J Clin Oncol. 2003;21(6):1107–18.

    Article  PubMed  Google Scholar 

  34. De Wit R, Skoneczna A, Gedske Daugaard K, et al. A randomized phase III study comparing paclitaxel-BEP (T-BEP) to standard BEP in patients with in intermediate prognosis germ cell cancer (GCC): An intergroup study of EORTC, German TCSG/AUO, MRC, and Spanish GCC group (EORTC 30983). J Clin Oncol (Abst). 2011; 29(15_suppl):4509.

    Google Scholar 

  35. Christian JA, Huddart RA, Norman A, et al. Intensive induction chemotherapy with CBOP/BEP in patients with poor prognosis germ cell tumors. J Clin Oncol. 2003;21(5):871–7.

    Article  CAS  PubMed  Google Scholar 

  36. Olofsson SE, Tandstad T, Jerkeman M, et al. Population-based study of treatment guided by tumor marker decline in patients with metastatic nonseminomatous germ cell tumor: a report from the Swedish-Norwegian Testicular Cancer Group. J Clin Oncol. 2011;29(15):2032–9.

    Article  PubMed  Google Scholar 

  37. Motzer RJ, Nichols CJ, Margolin KA, et al. Phase III randomized trial of conventional-dose chemotherapy with or without high-dose chemotherapy and autologous hematopoietic stem-cell rescue as first-line treatment for patients with poor-prognosis metastatic germ cell tumors. J Clin Oncol. 2007;25(3):247–56.

    Article  CAS  PubMed  Google Scholar 

  38. Gillessen S, Powles T, Lim L, et al. Low-dose induction chemotherapy with Baby-BOP in patients with metastatic germ-cell tumours does not compromise outcome: a single-centre experience. Ann Oncol. 2010;21(8):1589–93.

    Article  CAS  PubMed  Google Scholar 

  39. Zon RT, Nichols C, Einhorn LH. Management strategies and outcomes of germ cell tumor patients with very high human chorionic gonadotropin levels. J Clin Oncol. 1998;16(4):1294–7.

    CAS  PubMed  Google Scholar 

  40. Schneider BP, Kesler KA, Brooks JA, Yiannoutsos C, Einhorn LH. Outcome of patients with residual germ cell or non-germ cell malignancy after resection of primary mediastinal nonseminomatous germ cell cancer. J Clin Oncol. 2004;22(7):1195–200.

    Article  PubMed  Google Scholar 

  41. Lorch A, Beyer J, Bascoul-Mollevi C, et al. Prognostic factors in patients with metastatic germ cell tumors who experienced treatment failure with cisplatin-based first-line chemotherapy. J Clin Oncol. 2010;28(33):4906–11.

    Article  PubMed  Google Scholar 

  42. Gerlinger M, Wilson P, Powles T, Shamash J. Elevated LDH predicts poor outcome of recurrent germ cell tumours treated with dose dense chemotherapy. Eur J Cancer. 2010;46(16):2913–8.

    Article  CAS  PubMed  Google Scholar 

  43. Loehrer Sr PJ, Lauer R, Roth BJ, et al. Salvage therapy in recurrent germ cell cancer: ifosfamide and cisplatin plus either vinblastine or etoposide. Ann Intern Med. 1988;109(7):540–6.

    Article  PubMed  Google Scholar 

  44. Farhat F, Culine S, Theodore C, et al. Cisplatin and ifosfamide with either vinblastine or etoposide as salvage therapy for refractory or relapsing germ cell tumor patients: the Institut Gustave Roussy experience. Cancer. 1996;77(6):1193–7.

    Article  CAS  PubMed  Google Scholar 

  45. Kondagunta GV, Bacik J, Donadio A, et al. Combination of paclitaxel, ifosfamide, and cisplatin is an effective second-line therapy for patients with relapsed testicular germ cell tumors. J Clin Oncol. 2005;23(27):6549–55.

    Article  CAS  PubMed  Google Scholar 

  46. Levi JA, Thomson D, Harvey V, et al. Effective salvage chemotherapy with etoposide, dactinomycin, and methotrexate in refractory germ cell cancer. Australasian Germ Cell Trial Group. J Clin Oncol. 1990;8(1):27–32.

    CAS  PubMed  Google Scholar 

  47. Picton TW, van Roon P, John MS. Human auditory steady-state responses during sweeps of intensity. Ear Heart. 2007;28(4):542–57.

    Article  Google Scholar 

  48. Kollmannsberger C, Rick O, Derigs HG, et al. Activity of oxaliplatin in patients with relapsed or cisplatin-refractory germ cell cancer: a study of the German Testicular Cancer Study Group. J Clin Oncol. 2002;20(8):2031–7.

    Article  CAS  PubMed  Google Scholar 

  49. Kollmannsberger C, Rick O, Klaproth H, et al. Irinotecan in patients with relapsed or cisplatin-refractory germ cell cancer: a phase II study of the German Testicular Cancer Study Group. Br J Cancer. 2002;87(7):729–32.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  50. Beyer J, Kramar A, Mandanas R, et al. High-dose chemotherapy as salvage treatment in germ cell tumors: a multivariate analysis of prognostic variables. J Clin Oncol. 1996;14(10):2638–45.

    CAS  PubMed  Google Scholar 

  51. Siegert W, Beyer J, Strohscheer I, et al. High-dose treatment with carboplatin, etoposide, and ifosfamide followed by autologous stem-cell transplantation in relapsed or refractory germ cell cancer: a phase I/II study. The German Testicular Cancer Cooperative Study Group. J Clin Oncol. 1994;12(6):1223–31.

    CAS  PubMed  Google Scholar 

  52. Einhorn LH, Williams SD, Chamness A, et al. High-dose chemotherapy and stem-cell rescue for metastatic germ-cell tumors. N Engl J Med. 2007;357(4):340–8.

    Article  CAS  PubMed  Google Scholar 

  53. Kondagunta GV, Bacik J, Sheinfeld J, et al. Paclitaxel plus Ifosfamide followed by high-dose carboplatin plus etoposide in previously treated germ cell tumors. J Clin Oncol. 2007;25(1):85–90.

    Article  CAS  PubMed  Google Scholar 

  54. Lorch A, Kleinhans A, Kramar A, et al. Sequential versus single high-dose chemotherapy in patients with relapsed or refractory germ cell tumors: long-term results of a prospective randomized trial. J Clin Oncol. 2012;30(8):800–5.

    Article  CAS  PubMed  Google Scholar 

  55. Lorch A, Bascoul-Mollevi C, Kramar A, et al. Conventional-dose versus high-dose chemotherapy as first salvage treatment in male patients with metastatic germ cell tumors: evidence from a large international database. J Clin Oncol. 2011;29(16):2178–84.

    Article  PubMed  Google Scholar 

  56. Lorch A, Neubauer A, Hackenthal M, et al. High-dose chemotherapy (HDCT) as second-salvage treatment in patients with multiple relapsed or refractory germ-cell tumors. Ann Oncol. 2010;21(4):820–5.

    Article  CAS  PubMed  Google Scholar 

  57. Bokemeyer C, Nowak P, Haupt A, et al. Treatment of brain metastases in patients with testicular cancer. J Clin Oncol. 1997;15(4):1449–54.

    CAS  PubMed  Google Scholar 

  58. Bedano PM, Brames MJ, Williams SD, et al. Phase II study of cisplatin plus epirubicin salvage chemotherapy in refractory germ cell tumors. J Clin Oncol. 2006;24(34):5403–7.

    Article  CAS  PubMed  Google Scholar 

  59. Saxman S. Oral etoposide in germ cell tumours. Drugs. 1999;58 Suppl 3:31–4.

    Article  CAS  PubMed  Google Scholar 

  60. Pectasides D, Nikolaou M, Pectasides E, et al. Complete response after imatinib mesylate administration in a patient with chemoresistant stage IV seminoma. Anticancer Res. 2008;28(4C):2317–20.

    CAS  PubMed  Google Scholar 

  61. Oechsle K, Honecker F, Cheng T, et al. Preclinical and clinical activity of sunitinib in patients with cisplatin-refractory or multiply relapsed germ cell tumors: a Canadian Urologic Oncology Group/German Testicular Cancer Study Group cooperative study. Ann Oncol. 2011;22(12):2654–60.

    Article  CAS  PubMed  Google Scholar 

  62. Calaminus G, Schneider DT, Weissbach L, et al. Survival after an antiangiogenetic therapy and surgery in a wide spread growing teratoma originating from a testicular mixed malignant germ cell tumor. Klin Padiatr. 2009;221(3):136–40.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medical Oncology, St. Bartholomew’s Hospital, London, UK

    Jonathan Shamash MD, FRCP

Authors
  1. Jonathan Shamash MD, FRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jonathan Shamash MD, FRCP .

Editor information

Editors and Affiliations

  1. Department of Urology, Homerton University Hospital & Formerly St. Bartholomew's Hospital, London, United Kingdom

    Vinod H. Nargund

  2. Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina, USA

    Derek Raghavan

  3. Radiation Oncology, Cedars Sinai Cancer Center, Los Angeles, California, USA

    Howard M. Sandler

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag London

About this chapter

Cite this chapter

Shamash, J. (2015). Chemotherapy for Testicular Cancer. In: Nargund, V., Raghavan, D., Sandler, H. (eds) Urological Oncology. Springer, London. https://doi.org/10.1007/978-0-85729-482-1_29

Download citation

  • DOI: https://doi.org/10.1007/978-0-85729-482-1_29

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-0-85729-481-4

  • Online ISBN: 978-0-85729-482-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation