Salvage therapy for germ cell tumors.

Testicular cancer has become a model for a curable neoplasm. Approximately 70% of patients with disseminated disease will be cured with first-line chemotherapy regimens like cisplatin/etoposide/bleomycin. The concept of salvage therapy is simply to use active drugs not previously used in combination with cisplatin, the most active single agent. This strategy can be used with curative intent if the patient did not exhibit progressive disease during his initial cisplatin combination chemotherapy. Vinblastine/ifosfamide/cisplatin will cure approximately 25% of patients when used as second-line therapy. The cure rate for extragonadal presentation is extremely low, however. High-dose chemotherapy with carboplatin and etoposide with autologous bone marrow transplantation can cure 15% to 20% of patients whose disease progressed during prior cisplatin combination chemotherapy, or when the regimen is used as third-line or later chemotherapy. We are currently evaluating autologous bone marrow transplantation as initial salvage therapy.