This protocol applies to patients with seminoma at stage IIB or III who meet the IGCCCG good prognosis criteria — including a normal serum alpha-fetoprotein (AFP) — and who are fit to receive cisplatin-based chemotherapy.

Clinical Scenario

Qualifying patients have stage IIB–III seminoma classified as IGCCCG good prognosis: no non-pulmonary visceral metastases, normal AFP at any hCG level, and sufficient fitness for cisplatin-containing treatment. Cisplatin-based chemotherapy guided by IGCCCG classification is the established standard for this stage and prognosis group.

Treatment Approach

The regimen incorporates a specific combination chemotherapy backbone, with consideration of additional cytotoxic agents depending on prior therapy exposure. Surgical resection may also be incorporated when responding disease becomes amenable to resection. The complete agent selection, sequencing, and decision criteria are detailed in the full protocol.

References

Three cycles of BEP represents the standard therapy for seminoma patients categorised as good prognosis and four cycles of BEP for intermediate prognosis.
Cisplatin-based ChT according to the IGCCCG classification is standard for seminoma stage IIB-IIC and III.
The combination of gemcitabine and oxaliplatin (plus paclitaxel if not used in earlier lines) achieved remission response rates of up to 40% and if responding patients become resectable, long-term survival is reached in about 10%-15% of these patients.
Surgery should be part of the salvage strategy whenever possible, particularly in those patients with localised or late relapse, and with poor response to ChT.

DOI: 10.1016/j.annonc.2022.01.002

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Treatment of Seminoma Stage IIB–III with IGCCCG Good Prognosis and Normal Serum AFP

References