Metastatic Germ Cell Cancer: The Intermediate-Prognosis Risk Category

  • Carsten BokemeyerEmail author
  • Christoph Seidel


With the identification of several patient characteristics with prognostic impact on long term survival a scoring system was introduced in 1997 by the International Germ Cell Cancer Collaborative Group (IGCCCG) resulting in “good”, “intermediate” and “poor” prognosis. Patients of the intermediate prognosis category reached a five year overall survival (OS) of 79%. The standard therapy for the intermediate prognosis patients consisted of four cycles of cisplatin, etoposide and bleomycin (BEP). Within this book chapter we present and discuss the clinical trials that were performed to test treatment regimens for intermediate prognosis patients. The review of these trials revealed amongst others that the application of more aggressive treatment regimens such as high dose chemotherapy did not automatically lead to improved outcome. However, regardless of the absence of a superiority of new regimens compared to the standard BEP regimen, almost every trial has demonstrated that the outcome for intermediate prognosis patients has improved over the past years compared to the data presented by the IGCCCG. Experience of the treating therapists and the improvement of supportive care such as the application of novel antiemetics and the use of growth factors may have led to this advance. On this note some authors even conclude that some intermediate risk patients may be overtreated by four cycles of BEP. Therefore an individual treatment adjustment may be a reasonable option, and indeed one clinical trial registry demonstrated a 10-year OS of 90.0% with a strategy by controlling the treatment intensity based on the decline of the tumor markers. However, clinical trials which are prospectively testing a dosing deescalation strategy are not available.


Overall Survival Germ Cell Tumor Germ Cell Cancer Nonseminomatous Germ Cell Tumor Intermediate Prognosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers. International Germ Cell Cancer Collaborative Group. J Clin Oncol. 1997;15(2):594–603.Google Scholar
  2. 2.
    de Wit R, Stoter G, Sleijfer DT, Neijt JP, ten Bokkel Huinink WW, de Prijck L, Collette L, Sylvester R. Four cycles of BEP vs four cycles of VIP in patients with intermediate-prognosis metastatic testicular non-seminoma: a randomized study of the EORTC Genitourinary Tract Cancer Cooperative Group. European Organization for Research and Treatment of Cancer. Br J Cancer. 1998;78(6):828–32.CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Bokemeyer C, Beyer J, Metzner B, Ruther U, Harstrick A, Weissbach L, Kohrmann U, Verbeek W, Schmoll HJ. Phase II study of paclitaxel in patients with relapsed or cisplatin refractory testicular cancer. Ann Oncol. 1996;7:31–40.CrossRefPubMedGoogle Scholar
  4. 4.
    de Wit R, Louwerens M, de Mulder PH, Verweij J, Rodenhuis S, Schornagel J. Management of intermediate-prognosis germ-cell cancer: results of a phase I/II study of Taxol-BEP. Int J Cancer. 1999;83(6):831–3.CrossRefPubMedGoogle Scholar
  5. 5.
    de Wit R, Skoneczna I, Daugaard G, De Santis M, Garin A, Aass N, Witjes AJ, Albers P, White JD, Germa-Lluch JR, Marreaud S, Collette L. Randomized phase III study comparing paclitaxel-bleomycin, etoposide, and cisplatin (BEP) to standard BEP in intermediate-prognosis germ-cell cancer: intergroup study EORTC 30983. J Clin Oncol. 2012;30(8):792–9. doi: 10.1200/JCO.2011.37.0171.CrossRefPubMedCentralPubMedGoogle Scholar
  6. 5.
    Oldenburg J, Fosså SD, Nuver J, Heidenreich A, Schmoll HJ, Bokemeyer C, Horwich A, Beyer J, Kataja V, ESMO Guidelines Working Group. Testicular seminoma and non-seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24 Suppl 6:vi125–32. doi: 10.1093/annonc/mdt304. No abstract available.CrossRefPubMedGoogle Scholar
  7. 6.
    Feldman DR, Hu J, Dorff TB, Patil S, Van Alstine LJ, Momen L, Carousso M, Hughes A, Snively-Solomon J, Ketchens C, Sheinfeld J, Bains MS, Bajorin DF, Bosl GJ, Motzer RJ, Quinn DI. Paclitaxel, ifosfamide, and cisplatin (TIP) efficacy for first-line treatment of patients (pts) with intermediate- or poor-risk germ cell tumors (GCT). J Clin Oncol. 2013;31 (suppl; abstr 4501).Google Scholar
  8. 7.
    Culine S, Kramar A, Théodore C, Geoffrois L, Chevreau C, Biron P, Nguyen BB, Héron JF, Kerbrat P, Caty A, Delva R, Fargeot P, Fizazi K, Bouzy J, Droz JP, Genito-Urinary Group of the French Federation of Cancer Centers Trial T93MP. Randomized trial comparing bleomycin/etoposide/cisplatin with alternating cisplatin/cyclophosphamide/doxorubicin and vinblastine/bleomycin regimens of chemotherapy for patients with intermediate- and poor-risk metastatic nonseminomatous germ cell tumors: Genito-Urinary Group of the French Federation of Cancer Centers Trial T93MP. J Clin Oncol. 2008;26(3):421–7. doi: 10.1200/JCO.2007.13.8461.CrossRefPubMedGoogle Scholar
  9. 8.
    Motzer RJ, Nichols CJ, Margolin KA, Bacik J, Richardson PG, Vogelzang NJ, Bajorin DF, Lara Jr PN, Einhorn L, Mazumdar M, Bosl GJ. Phase III randomized trial of conventional-dose chemotherapy with or without high-dose chemotherapy and autologous hematopoietic stem-cell rescue as first-line treatment for patients with poor-prognosis metastatic germ cell tumors. J Clin Oncol. 2007;25(3):247–56.CrossRefPubMedGoogle Scholar
  10. 9.
    Albany C, Satpute SR, Brames MJ, Suleiman Y, Al Nasrallah N, Perkins SM, Hanna NH, Einhorn LH. A retrospective analysis of patients with intermediate-risk germ cell tumor (IRGCT) treated at Indiana University from 2000 to 2010. J Clin Oncol. 2012;30 (suppl; abstr 4534).Google Scholar
  11. 10.
    Olofsson SE, Tandstad T, Jerkeman M, Dahl O, Ståhl O, Klepp O, Bremnes RM, Cohn-Cedermark G, Langberg CW, Laurell A, Solberg A, Stierner U, Wahlqvist R, Wijkström H, Anderson H, Cavallin-Ståhl E. Population-based study of treatment guided by tumor marker decline in patients with metastatic nonseminomatous germ cell tumor: a report from the Swedish-Norwegian Testicular Cancer Group. J Clin Oncol. 2011;29(15):2032–9. doi: 10.1200/JCO.2010.29.1278.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Department of Oncology, Hematology and Bone Marrow Transplantation with Section PneumologyUniversity Hospital Hamburg-EppendorfHamburgGermany

Personalised recommendations