High-dose chemotherapy and hematopoietic stem cell transplantation in patients with germ cell cancer

In cases of germ cell tumors, urologists cooperate with oncologists to determine the best timing for high-dose chemotherapy (HDC). In the primary treatment of patients with "intermediate" and "poor" prognosis, HDC conveys no benefit. These patients are treated with four cycles of cisplatin, etoposide, and bleomycin (BEP). After failure of the standard therapy again four cycles of conventional-dose combination chemotherapy are necessary in good prognosis patients: cisplatin, ifosfamide and either etoposide (VIP or PEI), vinblastine (VeIP) or paclitaxel (TIP). HDC should be considered in patients who fail primary treatment, and who show unfavorable prognostic features prior to salvage treatment.