Next-Line Treatment for Poor Prognosis Metastatic NSGCT After Surgical Resection Failed to Achieve Complete Resection
This protocol covers the clinical step taken in metastatic non-seminomatous germ cell tumour (NSGCT) classified as IGCCCG poor prognosis, when bilateral nerve-sparing retroperitoneal lymph node dissection and resection of residual masses did not achieve complete resection.
Patient Population — IGCCCG Poor Prognosis Criteria
At least one of the following must be present:
- Mediastinal primary tumour
- Non-pulmonary visceral metastases
- AFP > 10,000 ng/mL
- hCG > 50,000 IU/L
- LDH > 10 × upper limit of normal
Previous Treatment — Failure Condition
Surgical resection of residual retroperitoneal masses (bilateral nerve-sparing retroperitoneal lymph node dissection), including resection at all residual sites, did not achieve complete resection. This protocol defines the next treatment step following that failure.
Treatment Approach
Salvage chemotherapy using a cisplatin- and ifosfamide-containing combination is indicated. The specific regimen selection, clinical sequencing, and full dosing algorithm are available in the structured protocol.
Clinical goals: Normalisation of serum tumour markers; complete or partial radiological response.
References
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 regimens of choice are four cycles of a three-agent regimen including cisplatin and ifosfamide plus a third drug: etoposide (VIP), paclitaxel (TIP), or potentially gemcitabine (GIP).
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