Behandeling van gemetastaseerd testiscarcinoom, naar prognose, en nieuwe ontwikkelingen

- The majority of patients with a metastatic germ cell tumour can be successfully treated with a combination chemotherapy containing cisplatin. For more than a decade the combination of cisplatin, etoposide and bleomycin (BEP) has been the gold standard of treatment.

- In both the United States and Europe, a number of studies have been carried out, with the purpose of reducing the toxicity of the treatment for patients with a good prognosis as well as improving the treatment result for patients with intermediate or unfavourable prognostic characteristics, by intensifying the chemotherapy regimen or by adding new cytotoxic agents.

- The standard treatment for patients with a good prognosis consists at present of three BEP cycles, which can be administered in a shortened schedule of three days per cycle.

- Bleomycin is essential for the success of the therapy and cisplatin cannot be replaced by carboplatin.

- Efforts to increase the dose of cisplatin per cycle, reduce the interval between cycles, the addition of ifosfamide and sequential/alternating therapy do not provide any additional benefit compared to the standard treatment with BEP.