Salvage chemotherapy for refractory germ cell tumors.

At the University of Southern California (USC), it is our practice to begin by estimating the likelihood of a durable remission based on individual characteristics. Factors including pure seminoma, prior complete response (CR) to cisplatin therapy, low-volume metastases, and a testicular primary predict for cure with standard-dose salvage[1-4] and may help clinicians identify patients for whom SDC is preferred. However, it is important to consider that HDC-ASCR may be more effective in patients at first relapse, even in populations expected to respond to SDC salvage, and it may also be safer when administered earlier. For example, in a series of relapsed seminoma patients treated with HDC, 92% of patients in first relapse achieved CR, compared with 67% of those treated in the thirdor fourth-line setting.[5] There have been reports of greater toxicity from ASCR in germ cell tumor patients with greater prior cisplatin exposure.[6]