Current status and future perspectives in chemotherapy for testicular cancer

Approximately eighty percent of patients with disseminated testicular cancer can currently be cured because of the progress in cisplatin-based chemotherapy. For good risk disseminated disease, three courses of bleomycin, etoposide and cisplatin (BEP) is the most reliable induction chemotherapy. Cisplatin, ifostamide and either etoposide or vinblastine (VIP or VeIP) is effective standard-dose salvage chemotherapy, especially for relapsed patients with good prognosis features. However, remission is of short duration in many cases, resulting in an overall long-term disease-free survival rate of 10% to 25%. One possible approach to improve outcome is drug-dose increment. In recent years, high-dose chemotherapy (HDCT) with autologous stem-cell rescue has been used with some success in the first relapse cases and refractory cases. Although these non-randomized data are promising, the clinical benefit of HDCT remains to be confirmed in an ongoing randomized study. Another strategy is to include a new active drug in the chemotherapy regimen. Recent studies combining new active agents such as paclitaxel, gemcitabine and irinotecan have showed promising results in patients with poor prognostic disease or as salvage therapy.