How Should Patients with Recurrent Disease Be Treated Actually?

  • Anja LorchEmail author


It was the unsatisfactory results of conventional-dose chemotherapy at the time of relapse, that led to HDCT being introduced into clinical practice. Even today, the combination of carboplatin and etoposide (CE) remains the mainstay of all salvage regimens with HDCT. The use of HDCT has resulted in long-term remission being achieved even in patients with unfavorable prognoses or multiple relapses. What remains controversial, however, is the role of HDCT as first-line salvage therapy in relapsed patients with highly favorable risk profiles. In order to avoid overtreatment, HDCT should only be administered at specialist centres with the necessary expertise.


Germ cell tumor Relapse High-dose chemotherapy Prognosis 


  1. 1.
    Anonymous. Prognostic factors in patients with metastatic germ cell tumors who experienced treatment failure with cisplatin-based first-line chemotherapy. J Clin Oncol. 2010;28:4906–11.Google Scholar
  2. 2.
    Beyer J, Albers P, Altena R, et al. Maintaining success, reducing treatment burden, focusing on survivorship: highlights from the third European consensus conference on diagnosis and treatment of germ-cell cancer. Ann Oncol. 2013;24:878–88.CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Beyer J, Schwella N, Zingsem J, et al. Hematopoietic rescue after high-dose chemotherapy using autologous peripheral-blood progenitor cells or bone marrow: a randomized comparison. J Clin Oncol. 1995;13:1328–35.PubMedGoogle Scholar
  4. 4.
    Beyer J, Stenning S, Gerl A, et al. High-dose versus conventional-dose chemotherapy as first-salvage treatment in patients with non-seminomatous germ-cell tumors: a matched-pair analysis. Ann Oncol. 2002;13:599–605.CrossRefPubMedGoogle Scholar
  5. 5.
    Bokemeyer C, Oechsle K, Honecker F, et al. Combination chemotherapy with gemcitabine, oxaliplatin, and paclitaxel in patients with cisplatin-refractory or multiply relapsed germ-cell tumors: a study of the German Testicular Cancer Study Group. Ann Oncol. 2008;19:448–53.CrossRefPubMedGoogle Scholar
  6. 6.
    Einhorn LH, Williams SD, Chamness A, et al. High-dose chemotherapy and stem-cell rescue for metastatic germ-cell tumors. N Engl J Med. 2007;357:340–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Feldman DR, Bosl GJ, Sheinfeld J, et al. Medical treatment of advanced testicular cancer. JAMA. 2008;299:672–84.CrossRefPubMedGoogle Scholar
  8. 8.
    Kondagunta GV, Bacik J, Donadio A, et al. Combination of paclitaxel, ifosfamide, and cisplatin is an effective second-line therapy for patients with relapsed testicular germ cell tumors. J Clin Oncol. 2005;23:6549–55.CrossRefPubMedGoogle Scholar
  9. 9.
    Kondagunta GV, Bacik J, Sheinfeld J, et al. Paclitaxel plus Ifosfamide followed by high-dose carboplatin plus etoposide in previously treated germ cell tumors. J Clin Oncol. 2007;25:85–90.CrossRefPubMedGoogle Scholar
  10. 10.
    Kondagunta GV, Motzer RJ. Chemotherapy for advanced germ cell tumors. J Clin Oncol. 2006;24:5493–502.CrossRefPubMedGoogle Scholar
  11. 11.
    Kondagunta V, Galsky MD, Sonpavde G. Germ-cell tumors. N Engl J Med. 2007;357:1773; author reply 1773–4.PubMedGoogle Scholar
  12. 12.
    Lorch A, Bascoul-Mollevi C, Kramar A, et al. Conventional-dose versus high-dose chemotherapy as first salvage treatment in male patients with metastatic germ cell tumors: evidence from a large international database. J Clin Oncol. 2011;29:2178–84.CrossRefPubMedGoogle Scholar
  13. 13.
    Lorch A, Kleinhans A, Kramar A, et al. Sequential versus single high-dose chemotherapy in patients with relapsed or refractory germ cell tumors: long-term results of a prospective randomized trial. J Clin Oncol. 2012;30:800–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Lorch A, Neubauer A, Hackenthal M, et al. High-dose chemotherapy (HDCT) as second-salvage treatment in patients with multiple relapsed or refractory germ-cell tumors. Ann Oncol. 2010;21:820–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Motzer RJ, Mazumdar M, Sheinfeld J, et al. Sequential dose-intensive paclitaxel, ifosfamide, carboplatin, and etoposide salvage therapy for germ cell tumor patients. J Clin Oncol. 2000;18:1173–80.PubMedGoogle Scholar
  16. 16.
    Nichols CR, Tricot G, Williams SD, et al. Dose-intensive chemotherapy in refractory germ cell cancer–a phase I/II trial of high-dose carboplatin and etoposide with autologous bone marrow transplantation. J Clin Oncol. 1989;7:932–9.PubMedGoogle Scholar
  17. 17.
    Pico JL, Rosti G, Kramar A, et al. A randomised trial of high-dose chemotherapy in the salvage treatment of patients failing first-line platinum chemotherapy for advanced germ cell tumours. Ann Oncol. 2005;16:1152–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Sammler C, Beyer J, Bokemeyer C, et al. Risk factors in germ cell tumour patients with relapse or progressive disease after first-line chemotherapy: evaluation of a prognostic score for survival after high-dose chemotherapy. Eur J Cancer. 2008;44:237–43.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Genitourinary Medical Oncology/ Department of UrologyUniversity Hospital DüsseldorfDüsseldorfGermany

Personalised recommendations