Current pharmacotherapy for testicular germ cell cancer

TY - JOUR

T1 - Current pharmacotherapy for testicular germ cell cancer

AU - Alsdorf, Winfried

AU - Seidel, Christoph

AU - Bokemeyer, Carsten

AU - Oing, Christoph

PY - 2019/5

Y1 - 2019/5

N2 - INTRODUCTION: With the implementation of platinum-based chemotherapy, germ cell tumors (GCTs) became a model for a curable solid tumor, with survival rates of 95% in all patients with >80% survival in metastatic stages. Areas covered: Herein, the authors review the current standards of adjuvant chemotherapy for stage I GCTs as well as first-line and salvage treatments for metastatic disease. Novel approaches for refractory disease are also reviewed. Expert opinion: Active surveillance should be considered for all stage I patients and is the preferred approach for stage I seminoma. In stage I non-seminomas with vascular invasion, one cycle of bleomycin, etoposide, and cisplatin (BEP) substantially reduces the relapse risk. For most advanced GCTs, BEP remains the first-line standard of care. For poor prognosis disease treatment, stratification according to tumor marker decline is recommended. The role of primary high-dose chemotherapy (HDCT) for selected very high-risk patients remains to be prospectively evaluated. Salvage HDCT at relapse seems superior to conventional chemotherapy, retrospectively. The treatment of multiply relapsed disease remains challenging. The gemcitabine/oxaliplatin/paclitaxel (GOP) protocol is considered the standard for refractory disease. However, overall, outcomes are poor and new treatment approaches are urgently needed with targeted therapies so far failing to yield relevant clinical activity.

AB - INTRODUCTION: With the implementation of platinum-based chemotherapy, germ cell tumors (GCTs) became a model for a curable solid tumor, with survival rates of 95% in all patients with >80% survival in metastatic stages. Areas covered: Herein, the authors review the current standards of adjuvant chemotherapy for stage I GCTs as well as first-line and salvage treatments for metastatic disease. Novel approaches for refractory disease are also reviewed. Expert opinion: Active surveillance should be considered for all stage I patients and is the preferred approach for stage I seminoma. In stage I non-seminomas with vascular invasion, one cycle of bleomycin, etoposide, and cisplatin (BEP) substantially reduces the relapse risk. For most advanced GCTs, BEP remains the first-line standard of care. For poor prognosis disease treatment, stratification according to tumor marker decline is recommended. The role of primary high-dose chemotherapy (HDCT) for selected very high-risk patients remains to be prospectively evaluated. Salvage HDCT at relapse seems superior to conventional chemotherapy, retrospectively. The treatment of multiply relapsed disease remains challenging. The gemcitabine/oxaliplatin/paclitaxel (GOP) protocol is considered the standard for refractory disease. However, overall, outcomes are poor and new treatment approaches are urgently needed with targeted therapies so far failing to yield relevant clinical activity.

KW - Antineoplastic Combined Chemotherapy Protocols/therapeutic use

KW - Bleomycin/administration & dosage

KW - Cisplatin/administration & dosage

KW - Etoposide/administration & dosage

KW - Humans

KW - Male

KW - Neoplasm Recurrence, Local

KW - Neoplasms, Germ Cell and Embryonal/drug therapy

KW - Prognosis

KW - Salvage Therapy

KW - Testicular Neoplasms/drug therapy

U2 - 10.1080/14656566.2019.1583745

DO - 10.1080/14656566.2019.1583745

M3 - SCORING: Review article

C2 - 30849243

VL - 20

SP - 837

EP - 850

JO - EXPERT OPIN PHARMACO

JF - EXPERT OPIN PHARMACO

SN - 1465-6566

IS - 7

ER -