When BEP or VIP Did Not Achieve Complete Response in Stage IIB–III Seminoma with IGCCCG Intermediate Prognosis

This protocol applies to patients with stage IIB–III seminoma classified as IGCCCG intermediate prognosis whose first-line cisplatin-based chemotherapy has not achieved the required treatment endpoint, and in whom salvage treatment is now indicated.

Clinical Scenario

Stage IIB–III seminoma, IGCCCG intermediate prognosis classification: non-pulmonary visceral metastases present, AFP within normal limits, patient fit for cisplatin-based chemotherapy. Cisplatin-based chemotherapy according to IGCCCG classification is the standard approach for this stage and risk group, with four cycles of BEP as the reference first-line regimen, or VIP with G-CSF support when bleomycin is contraindicated.

Failure Condition Triggering This Protocol

First-line treatment — 4 cycles of BEP (bleomycin, etoposide, cisplatin) with prophylactic G-CSF, or 4 cycles of VIP (etoposide, ifosfamide, cisplatin) with G-CSF support — did not achieve the required endpoint: complete response with no residual disease on imaging and normalisation of serum tumour markers. This protocol defines the structured salvage step following that failure.

Salvage Approach (Partial Overview)

Salvage treatment is built around cisplatin-based combination chemotherapy. More than one regimen option exists within this class; the selection between them and any further sequencing is laid out in full in the protocol below.

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.

View source ↗