Treatment of Seminoma Stage IIB–III with IGCCCG Intermediate Prognosis and Non-Pulmonary Visceral Metastases
This protocol covers the management of seminoma classified as stage IIB–III meeting IGCCCG intermediate prognosis criteria — specifically where non-pulmonary visceral metastases are present, AFP is normal, and the patient is fit for cisplatin-based chemotherapy.
Clinical Scenario
The intermediate prognosis group is defined by non-pulmonary visceral metastases alongside a normal AFP level (hCG and LDH may be at any level). Cisplatin-based chemotherapy stratified by IGCCCG risk classification is the established standard for seminoma at stage IIB–III, with the number of cycles guided by prognosis group.
Treatment Approach
Management in this setting involves a combination chemotherapy regimen that includes gemcitabine, with surgical resection considered as an additional strategy when responding disease becomes resectable.
References
DOI: 10.1016/j.annonc.2022.01.002
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.
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