Testicular cancer
ICD-10 C62 · ICD-11 2C80

Metastatic NSGCT (IGCCCG Poor Prognosis) After Salvage Chemotherapy Has Failed to Achieve Marker Normalisation or Response

Clinical Scenario

This protocol addresses patients with non-seminomatous germ cell tumour (NSGCT) and metastatic disease classified in the IGCCCG poor prognosis group. Poor prognosis is defined by the presence of any one of the following:

Previous Line Did Not Achieve Its Goals

This protocol is the next step when salvage chemotherapy with VIP, TIP, or GIP has not achieved the goals of that line: normalisation of serum tumour markers and a complete or partial radiological response. This failure defines the indication for escalation to the current protocol.

Treatment Approach — Partial Overview

The approach at this stage involves high-dose chemotherapy combined with autologous stem cell transplantation. The complete structured regimen, including specific agents, sequential cycles, and supporting care, is available in the full protocol.

Instant Access to Structured Evidence-Based Regimens
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.

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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