Nakamura Terukazu, Miki Tsuneharu
The Depertment of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Hinyokika Kiyo. 2012 Dec;58(12):721-5.
In general, 80% of advanced germ cell tumors (GCTs) with metastasis can be cured, since clinical treatment guidelines for testicular cancer has been established after the International Germ Cell Cancer Collaborative Group announcement in 1997. Of those with advanced GCTs, 20-30% of the cases are defined as 'difficult-to-treat' GCTs. In particular, inadequate induction chemotherapy might result in "refractory" or "resistant" GCTs. In such cases, salvage chemotherapy will be required. Long-term survival can be guaranteed in 30% of the cases treated by conventional VIP (etoposide, ifosfamide, cisplatin) or VeIP (vinblastine, ifosfamide, cisplatin) therapy. Previously, high-dose chemotherapy (HDCT) was attemped to gain better results as induction therapy, but has not been shown to be superior to conventional chemotherapy. Furthermore a randomized control trial failed to show the superiority of HDCT as an induction therapy. Therefore, new drugs such as paclitaxel, gemcitabine and irinotecan have been used as salvage chemotherapy. Especially, TIP (paclitaxel, ifosfamide, cisplatin) therapy has become a new treatment option as first salvage chemotherapy in patients with favorable features such as testis primary and first relapse after complete remission. Regarding gemcitabine or irinotecan, some regimens have been reported in combination with oxaliplatin or paclitaxel. These studies were performed using multi-regimen chemotherapy, so the efficacy was limited. According to the Japanese guidelines for testicular cancer TIP therapy is recommendation grade B and gemcitabone-containing therapy is grade C. Currently, it is very difficult to conduct a randomized control trial on a large scale in a salvage setting. It is necessary to accumulate a number of cases with advanced GCTsin high-volume centers.
一般来说，80%发生转移的晚期生殖细胞肿瘤（GCT）可以治愈，这是因为自1997年国际生殖细胞癌协作组发布公告后，睾丸癌的临床治疗指南已经确立。在晚期GCT患者中，20%-30%的病例被定义为“难治性”GCT。特别是诱导化疗不足可能导致“难治性”或“耐药性”GCT。在这种情况下，就需要进行挽救性化疗。采用传统的VIP（依托泊苷、异环磷酰胺、顺铂）或VeIP（长春碱、异环磷酰胺、顺铂）疗法治疗的病例中，30%可保证长期生存。此前，曾尝试采用大剂量化疗（HDCT）作为诱导疗法以获得更好的效果，但尚未证明其优于传统化疗。此外，一项随机对照试验未能显示HDCT作为诱导疗法的优越性。因此，紫杉醇、吉西他滨和伊立替康等新药已被用作挽救性化疗药物。特别是，TIP（紫杉醇、异环磷酰胺、顺铂）疗法已成为一种新的治疗选择，作为首次挽救性化疗用于睾丸原发性且完全缓解后首次复发等具有良好特征的患者。关于吉西他滨或伊立替康，已有一些与奥沙利铂或紫杉醇联合使用的方案报道。这些研究采用了多种化疗方案，因此疗效有限。根据日本睾丸癌治疗指南，TIP疗法的推荐等级为B级，含吉西他滨的疗法为C级。目前，在挽救性治疗环境中很难大规模开展随机对照试验。有必要在大容量中心积累大量晚期GCT病例。
