Salvage Chemotherapy for Metastatic Seminoma When First-Line Treatment Has Not Achieved Tumour Marker Normalisation or Radiological Response (IGCCCG Intermediate Prognosis)
This protocol addresses metastatic seminoma germ cell tumour classified as IGCCCG intermediate prognosis, where standard first-line chemotherapy has failed to meet its defined response targets.
Clinical Scenario — IGCCCG Intermediate Prognosis
Patients in this group meet all of the following criteria:
- Any primary site
- Nonpulmonary visceral metastases
- Normal AFP (alpha-fetoprotein)
- Any hCG level
- Any LDH level
First-Line Failure — Escalation Trigger
First-line treatment with BEP × 4 (cisplatin, etoposide, bleomycin for 4 cycles at 21-day intervals) — or VIP × 4 (etoposide, cisplatin, ifosfamide for 4 cycles) when bleomycin is contraindicated — has not achieved its goals: normalisation of serum tumour markers and complete or partial radiological response. This failure defines the indication for the salvage protocol described here.
Salvage Approach
Salvage involves cisplatin and ifosfamide-based combination chemotherapy. The complete regimen selection and treatment algorithm are available in the full protocol.
Treatment Goals
Normalisation of serum tumour markers; complete or partial radiological response.
References
- All of the following criteria: Any primary site, Nonpulmonary visceral metastases, Normal AFP, Any hCG, Any LDH.
- 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).