This protocol covers first-line management of metastatic seminoma germ cell tumour at stage IIC or above, specifically in patients who meet the International Germ Cell Cancer Collaborative Group (IGCCCG) good prognosis criteria — defined by the absence of nonpulmonary visceral metastases and a normal serum alpha-fetoprotein.
Patients must meet all of the following criteria:
Primary chemotherapy is the standard of care for this stage and prognosis group. The approach uses platinum-based combination chemotherapy; an alternative regimen is available for patients in whom one component of the standard combination is contraindicated. The complete agent selection, cycle count, and scheduling are defined in the structured protocol.
Normalisation of serum tumour markers (hCG, LDH) and complete or partial radiological response on cross-sectional imaging.
All of the following criteria: Any primary site, No nonpulmonary visceral metastases, Normal AFP, Any hCG, Any LDH.
Treat seminoma stage IIC and higher, with primary chemotherapy according to IGCCCG classification (BEP x 3 in good-prognosis and BEP x 4 in intermediate prognosis).
The standard regimen in good-risk seminoma is three cycles of BEP.
Alternatively, EP x 4 may be considered, particularly when bleomycin is contraindicated.
View source ↗