Treatment of Metastatic Non-Seminomatous Germ Cell Tumour with Elevated AFP, hCG, or LDH — IGCCCG Intermediate Prognosis
This protocol covers first-line systemic management of metastatic non-seminomatous germ cell tumour (NSGCT) in patients classified as IGCCCG intermediate prognosis, characterised by primary site, absence of nonpulmonary visceral metastases, and intermediate-range elevation of serum tumour markers.
Clinical scenario
- Non-seminomatous germ cell tumour, metastatic disease (stage > IIC)
- Primary tumour: testis or retroperitoneal origin
- No nonpulmonary visceral metastases
- IGCCCG intermediate prognosis — defined by any one of the following serum marker criteria:
AFP 1,000–10,000 ng/mL · hCG 5,000–50,000 IU/L · LDH 1.5–10 × upper limit of normal
Treatment approach
Standard first-line management involves platinum-based combination chemotherapy delivered over multiple cycles. An alternative regimen exists for patients in whom one component of the standard combination is contraindicated. The complete regimen selection, cycle structure, and monitoring criteria are detailed in the full protocol.
Treatment goals: Normalisation of serum tumour markers (AFP, hCG, LDH) and complete or partial radiological response.
References
- Any of the following criteria: Testis/retro-peritoneal primary, No nonpulmonary visceral metastases. And any of the following criteria: AFP 1,000 - 10,000ng/mL or hCG 5,000 - 50,000 IU/L or LDH 1.5-10 x ULN.
- Treat metastatic NSGCT (stage > IIC) with an intermediate prognosis with four cycles of standard BEP.
- The standard regimen is BEP x 4.
- Four cycles of VIP has similar efficacy but is more myelotoxic.
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