Chemotherapy for good-risk metastatic germ-cell testicular tumours

In the international consensus classification, patients with good-risk characteristics are those patients free of non-pulmonary visceral metastases whatever the histological subtype and with serum tumour markers less than 1,000 ng/ml for alphafetoprotein, 5,000 IU/I for human chorionic gonadotrophin and 1.5 the normal range for lactate dehydrogenase for non-seminoma patients. The therapeutic gold standard includes primary chemotherapy followed by surgical resection of residual masses. The three major drugs are bleomycin (B), etoposide (E) and cisplatin (P). Over the last three decades a number of randomized clinical trials have been carried out to determine the optimal regimen to be delivered: 3 cycles of B(90)E(500)P for non-seminoma patients, 3 cycles of B(90)E(500)P or 4 cycles of E(500)P in seminoma patients. The recovery rates after chemotherapy and surgery approximate 90% in good-risk patients. Any deviation from standard doses or intervals is likely to reduce the chances of recovery.