Advanced Germ Cell Tumors
Germ cell tumors (GCT) in men, most commonly presenting in the testis and less commonly in the mediastinum and retroperitoneum, are highly curable. High doses of cisplatin (≥100 mg/m2 per cycle of therapy), added to drug combinations which include vinblastine and bleomycin (with or without cyclophosphamide and dactinomycin), and with adjunctive surgical resection of apparent residual sites of disease, will cure 70%–80% of patients with advanced metastatic GCT. Serum tumor markers play a vital role in patient management. α-fetoprotein (AFP) and human chorionic gonadotropin (HCG) are highly specific and sensitive markers, and radioimmunassays for both are routinely available. Lactate dehydrogenase (LDH) is another GCT marker and although less specific than AFP and HCG, it is equally valuable in patient management. Salvage chemotherapy with etoposide + cisplatin (EP) will cure 15%–25% of patients relapsing from complete remission and possibly a few patients with primarily refractory disease.
KeywordsToxicity Adduct Sarcoma Doxorubicin Neutropenia
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