Review: medical treatment of advanced testicular cancer

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In this article, the authors review the treatments used for advanced testicular germ cell tumours (GCT) and their associated short-term and long-term complications. The following are covered:

• Background – histology, genetics and risk group stratification
• Chemotherapy for the initial management of metastatic GCT (EP, BEP chemotherapy and salvage regimens)
• Surgery after chemotherapy
• Late relapses
• Acute and chronic toxicities of chemotherapy
• Fertility in GCT survivors
• Secondary malignancies

The authors conclude: “With overall cure rates of more than 95% (80% for metastatic disease), testicular GCT are considered the model for curable cancer. Physicians should be aware of the long-term risks in testicular cancer survivors, including infertility, late relapse, secondary malignancies, contralateral testicular cancer, and chronic co-morbidities, such as hypertension, hyperlipidaemia, heart disease, and the metabolic syndrome. Future research is likely to focus on recognizing and minimizing the late toxicities of therapy, and enhancing the genetic and biologic understanding of GCT to improve on current treatment options”.
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