Seminoma Stage IIB–III (IGCCCG Good Prognosis): Salvage Approach When BEP or EP Did Not Achieve Complete Response

This protocol covers the clinical situation where first-line chemotherapy for stage IIB–III seminoma with IGCCCG good prognosis has not met its targets, and a second-line strategy is required.

Patient Scenario

Stage IIB–III seminoma classified as IGCCCG good prognosis: no non-pulmonary visceral metastases, normal serum AFP (alpha-fetoprotein), any hCG level, and patient is fit for cisplatin-based chemotherapy.

First-Line Did Not Achieve Targets

Failure Condition That Prompts This Protocol

The prior regimen — 3 cycles of BEP (bleomycin, etoposide, cisplatin), or 4 cycles of EP (etoposide, cisplatin) when bleomycin is contraindicated — did not result in complete response: residual disease on imaging persisted or serum tumour markers did not normalise. This protocol is the defined next step after that outcome.

Salvage Approach (partial overview)

Salvage at this stage is centred on cisplatin-based combination chemotherapy. The specific regimen — selected according to the patient's profile and the clinical setting — is detailed in the full structured protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.annonc.2022.01.002

Cisplatin-based ChT according to the IGCCCG classification is standard for seminoma stage IIB-IIC and III.

Three cycles of BEP represents the standard therapy for seminoma patients categorised as good prognosis and four cycles of BEP for intermediate prognosis.

Salvage can be achieved with HD-ChT or standard-dose cisplatin-based regimens such as cisplatin, ifosfamide and paclitaxel (TIP), VIP or cisplatin, ifosfamide and vinblastine.

Second-line conventional dose ChT (e.g. TIP) at a specialist centre is recommended.

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