Metastatic NSGCT (IGCCCG Good Prognosis): Next-Line Protocol After Salvage Chemotherapy Failure
This protocol applies to patients with metastatic non-seminomatous germ cell tumour (NSGCT) classified in the IGCCCG good prognosis group, in whom prior salvage chemotherapy did not achieve adequate tumour marker normalisation or radiological response.
Patient population
IGCCCG good prognosis metastatic NSGCT — all of the following must be present:
- Testis or retroperitoneal primary
- No nonpulmonary visceral metastases
- AFP < 1,000 ng/mL
- hCG < 5,000 IU/L
- LDH < 1.5 × upper limit of normal
Escalation trigger — prior line inadequate
Previous treatment targets not met
Salvage chemotherapy (VIP, TIP, or GIP) was administered but failed to achieve normalisation of serum tumour markers or a complete or partial radiological response. This protocol defines the step taken after that failure.
Treatment approach (partial overview)
The approach involves high-dose chemotherapy with autologous stem cell support — an intensified strategy applied once standard salvage regimens have proven insufficient. The full regimen, sequencing, and selection criteria are detailed in the structured protocol.
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.
- HDCT with autologous stem cell support should be used although the prospect of cure is < 25%.
- When HDCT is used as a salvage treatment, sequential treatment cycles of high-dose carboplatin and etoposide (HD-CE) should be preferred to a single high-dose regimen as the former is associated with less toxicity-related deaths.
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