High-dose chemotherapy and autologous transplantation for testicular germ cell tumors

Testicular cancer is the most common solid organ malignancy affecting males between 15 and 35 years of age with an annual incidence of approximately 9300 in the United States.1 Germ cell tumors (GCTs) are the most common type of testicular cancer and are broadly categorized as seminomatous (SGCTs) and nonseminomatous germ cell tumors (NSGCTs). Therapeutic advances and utmost sensitivity to cisplatinbased combination chemotherapy make it one of the most curable solid neoplasms, even in the presence of metastatic disease with a 5year survival rate of approximately 95%.1 The standard chemotherapy regimen of bleomycin, etoposide, and cisplatin (BEP) cures a significant proportion of patients. However, despite these advances, a subset of patients have refractory disease or develop disease recurrence requiring salvage chemotherapy. Salvage chemotherapy options include conventionaldose chemotherapy (CDCT) with cisplatin and ifosfamide plus paclitaxel (TIP) or vinblastine (VeIP) or etoposide (VIP), or highdose chemotherapy with autologous hematopoietic stem cell transplantation (HDCT/HSCT).2-4 HDCT with HSCT has been available as a therapeutic option since 1986 and has provided cure to selected patients even as a third line regimen.5 We provide data for and our approach to the utilization of HDCT with HSCT in advanced GCTs.