NSGCT Clinical Stage I (pT1, No Lymphovascular Invasion): What to Do When Initial BEP Chemotherapy Fails

This protocol defines the structured next step for patients with non-seminomatous germ cell tumour (NSGCT) at clinical stage I, pT1, without lymphovascular invasion, whose initial adjuvant treatment course did not achieve the intended disease-control endpoints.

Clinical Scenario

The patient presents with pathological stage T1 NSGCT at clinical stage I, with no lymphovascular invasion (LVI). Absence of LVI is associated with lower relapse risk in this subgroup. Nonetheless, prior treatment has not maintained disease control, necessitating escalation.

Prior Treatment — Escalation Trigger

Previous therapy: Adjuvant chemotherapy with one course of cisplatin, etoposide, bleomycin (BEP).

Goals not achieved: Normalisation of serum tumour markers (AFP, hCG, LDH) and no evidence of relapse on cross-sectional imaging.

This protocol defines the approach taken when those endpoints are not met.

Treatment Approach (Partial Overview)

The next-line approach involves cisplatin-based chemotherapy, with the specific regimen selected according to the IGCCCG prognostic risk group determined at the time of relapse. The full regimen, decision algorithm, and criteria for selecting between options are contained in the structured protocol.

Clinical Goals

Treatment targets normalisation of serum tumour markers — AFP, hCG, and LDH — together with a complete or partial radiological response.

Instant Access to Structured Evidence-Based Regimens

References

For CS I NSGCT, invasion of the primary tumour into blood or lymphatic vessels, i.e. LVI, has long been described to be strongly associated with the risk of relapse.
Stage IA (pT1, no vascular invasion): low risk.
Discuss one course of cisplatin, etoposide, bleomycin as an adjuvant treatment alternative in patients with stage I non-seminomatous germ cell tumour if patients are not willing to undergo or comply with surveillance.

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