This page addresses the clinical management of metastatic testicular non-seminomatous germ cell tumour (NSGCT) that meets the IGCCCG poor prognosis classification. Identifying patients in this group is critical because it directly shapes the intensity and setting of treatment.
A patient is classified in the poor prognosis group if any one of the following is present:
Management involves a multi-agent, cisplatin-based combination chemotherapy regimen delivered over multiple cycles. An alternative combination with primary growth factor support is available for patients with specific contraindications. Treatment should be delivered at high-volume specialist centres.
The primary objectives are a favourable decline in serum tumour markers (AFP, hCG, LDH) after the first cycle of chemotherapy, followed by normalisation of all three markers. Marker decline after the first cycle is the prospectively confirmed predictor for treatment response in this setting.
Any of the following criteria: Mediastinal primary, Non-pulmonary visceral metastases, AFP > 10,000 ng/mL, hCG > 50,000 IU/L (10,000 ng/mL), LDH > 10 x ULN.
Treat metastatic NSGCT with a poor prognosis and favourable marker decline with four cycles of BEP.
The standard regimen is four cycles of BEP.
Four cycles of VIP have similar efficacy but is more myelotoxic.
Four cycles of VIP including primary granulocyte colony stimulating factor (G-CSF) prophylaxis should be applied in patients with contraindications to bleomycin.
Serum tumour marker decline is the only prospectively confirmed predictor for response to cisplatin chemotherapy in metastatic germ cell tumour patients.
Assess tumour marker decline after one cycle of standard chemotherapy in metastatic NSGCT with a poor-prognosis.
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