This protocol addresses patients with seminoma germ cell tumour at metastatic stage IIC or higher, classified in the IGCCCG good prognosis group, in whom a prior course of salvage chemotherapy did not achieve its intended goals.
The prior salvage chemotherapy regimen — VIP, TIP, or GIP — did not achieve the required outcomes: normalization of serum tumour markers and complete or partial radiological response. This protocol defines the treatment step taken after that failure.
Management involves high-dose chemotherapy combined with autologous stem cell transplantation. The complete regimen, sequencing, and clinical decision criteria are detailed in the full protocol.
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).
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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