Metastatic Non-Seminomatous Germ Cell Tumour, IGCCCG Good Prognosis: First-Line Treatment Approach
This protocol covers first-line systemic treatment for patients with metastatic non-seminomatous germ cell tumour (NSGCT) who meet all criteria for the IGCCCG good prognosis classification.
Clinical Scenario — IGCCCG Good Prognosis Criteria
All of the following must be present:
- Testis or retroperitoneal primary tumour
- No non-pulmonary visceral metastases
- AFP < 1,000 ng/mL
- hCG < 5,000 IU/L
- LDH < 1.5 × upper limit of normal
Treatment Approach
The standard first-line treatment for this prognosis group is a defined cisplatin-based combination chemotherapy regimen. An alternative regimen is reserved for patients with a clear contraindication to one of the agents.
Treatment Goals
Normalisation of serum tumour markers — AFP, hCG, and LDH — together with complete or partial radiological response on cross-sectional imaging.
References
All of the following criteria: Testis/retroperitoneal primary, No nonpulmonary visceral metastases, AFP < 1,000ng/mL, hCG < 5,000 IU/L (1,000ng/mL), LDH < 1.5 x ULN.
The standard regimen in good-risk non-seminoma is BEP x 3.
Based on these data, the BEP x 3 as a five-day regimen is strongly recommended in the good-prognosis risk group.
Patients with a clear contraindication to bleomycin may receive EP x 4.
In all other cases omission of bleomycin is not recommended.