A Review of Second-line Chemotherapy and Prognostic Models for Disseminated Germ Cell Tumors
Antineoplastic Combined Chemotherapy Protocols
Hematopoietic Stem Cell Transplantation
Neoplasms, Germ Cell and Embryonal
Despite an excellent prognosis even for patients with disseminated disease, about 20% to 30% of men with advanced germ cell tumors are refractory to first-line chemotherapy or experience disease recurrence after an initial remission with such treatment. Many of these are cured with conventional dose cisplatin/ifosfamide-based regimen or high-dose chemotherapy with stem cell rescue. Controversy exists regarding the optimal choice between these 2 second-line approaches, and available data for each is reviewed here. Clinical factors can help prognosticate patients, and recently an international effort developed a prognostic model for the second-line setting that can be universally applied in future studies.