Poor-Prognosis Germ Cell Tumours

摘要: In the International Germ Cell Cancer Consensus Group (IGCCCG) classification, a poor-risk group is defined as either having mediastinal primary NSGCT, extra-pulmonary visceral metastases or very high serum tumour marker levels (hCG > 50,000 UI/L, AFP 10,000 ng/mL and/or LDH 10 times upper limit value). This subgroup of 10% patients responsible for most deaths from GCT. Their progression-free survival rate 41 % with only half them achieving long-term overall survival. Four cycles BEP regimen (cisplatin, etoposide and bleomycin), followed by resection residual masses, became standard treatment this in 1987. After period 25 years during which all attempts to improve results failed, paradigm changed 2014 use personalized chemotherapy based on decline. That slow decline hCG after first cycle can single out likely fail conventional therapy was demonstrated retrospectively then confirmed prospectively. international GETUG-13 trial, once had received one BEP, favourable continued an unfavourable were randomised receive 6-drug dose-dense regimen, including drugs plus paclitaxel, oxaliplatin, ifosfamide, G-CSF support. The endpoint receiving improved: 59 [95 confidence interval (CI): 49–68] versus 48 CI: 38–59] (p = 0.05; HR: 0.66 [0.44–1.00]).The probability curing NSGCT managed according algorithm (BEP decline) now exceeds 75 %. Finally, more data support need centralise care some countries have already implemented policy at national level.