In this review, we summarize and discuss contemporary treatment standards and possible selection criteria for decision making after failure of adjuvant or first-line cisplatin-based chemotherapy for primarily localized or metastatic germ cell tumors.
This work is based on a systematic literature search conducted for the elaboration of the first German clinical practice guideline to identify prospective clinical trials and retrospective comparative studies published between Jan 2010 and Feb 2021. Study end points of interest were progression-free (PFS) and overall survival (OS), relapse rate (RR), and/or safety.
Relapses of clinical stage I (CS I) patients irrespective of prior adjuvant treatment after orchiectomy are treated stage adapted in accordance for primary metastatic patients. Surgical approaches for sole retroperitoneal relapses are investigated in ongoing clinical trials. The appropriate salvage chemotherapy for metastatic patients progressing or relapsing after first-line cisplatin-based chemotherapy is still a matter of controversy. Conventional cisplatin-based chemotherapy is the international guideline-endorsed standard of care, but based on retrospective data high-dose chemotherapy and subsequent autologous stem cell transplantation may offer a 10-15% survival benefit for all patients. Secondary complete surgical resection of all visible residual masses irrespective of size is paramount for treatment success.
Patients relapsing after definite treatment of locoregional disease are to be treated by stage-adapted first-line standard therapy for metastatic disease. Patients with primary advanced/metastatic disease failing one line of cisplatin-based combination chemotherapy should be referred to GCT expert centers. Dose intensity is a matter of ongoing debate, but sequential high-dose chemotherapy seems to improve patients' survival.
World journal of urology. 2022 Feb 28 [Epub ahead of print]
David Pfister, Karin Oechsle, Stefanie Schmidt, Jonas Busch, Carsten Bokemeyer, Axel Heidenreich, Julia Heinzelbecker, Christian Ruf, Christian Winter, Friedemann Zengerling, Sabine Kliesch, Peter Albers, Christoph Oing
Department of Urology, University Hospital Cologne, Cologne, Germany. ., Department of Oncology, Hematology and Bone Marrow Transplantation, University Medical Center Eppendorf, Hamburg, Germany., UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany., Department of Urology, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany., Department of Urology, University Hospital Cologne, Cologne, Germany., Department of Urology and Paediatric Urology, Saarland University Medical Centre and Saarland University Faculty of Medicine, Homburg, Saar, Germany., Department of Urology, Bundeswehrkrankenhaus (Armed Forces Hospital, Ulm), Ulm, Germany., Urologie Neandertal (Regional Joint Practice), Erkrath, Germany., Department of Urology, University Hospital Ulm, Ulm, Germany., Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, University Hospital Muenster, Muenster, Germany., Department of Urology, Medical Faculty, University Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany.