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<p>Advanced germ cell tumors (GCT) with bulky retroperitoneal lymph node metastases (≥ 5 cm, clinical stage [CS]&#xa0;IIC) or distant metastases (CS&#xa0;III) remain among the solid tumors with the highest cure rates despite an unfavorable prognosis. Pulmonary metastases are associated with better outcomes, whereas non-pulmonary visceral involvement indicates a&#xa0;poorer prognosis. Optimal results rely on strict adherence to guideline-based therapy and treatment in specialized centers. The standard first-line regimen remains cisplatin-based PEB (cisplatin, etoposide, bleomycin) combination chemotherapy, with EP (cisplatin, etoposide) or PEI (cisplatin, etoposide, ifosfamide) as alternatives in the case of bleomycin contraindication. Early treatment response, particularly tumor marker decline, is a&#xa0;key prognostic factor and may prompt treatment intensification. High-dose chemotherapy is the standard in the salvage setting; its role compared to conventional cisplatin, ifosfamide, and paclitaxel (TIP) chemotherapy is being prospectively evaluated in the international TIGER trial. Brain metastases are rare and usually managed with systemic therapy according to the poor-risk protocol, with surgery or stereotactic radiotherapy considered in selected cases. Early and late toxicities require consistent supportive care and structured long-term follow-up.</p>

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Systemische Therapie von Keimzelltumoren fortgeschrittener Stadien

  • 期刊论文

  • 发表日期：

    2026年1月9日

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  • Akin Kapucu,
  • Frederik Wessels,
  • Johannes Claßen,
  • Stefanie Zschäbitz

摘要

Advanced germ cell tumors (GCT) with bulky retroperitoneal lymph node metastases (≥ 5 cm, clinical stage [CS] IIC) or distant metastases (CS III) remain among the solid tumors with the highest cure rates despite an unfavorable prognosis. Pulmonary metastases are associated with better outcomes, whereas non-pulmonary visceral involvement indicates a poorer prognosis. Optimal results rely on strict adherence to guideline-based therapy and treatment in specialized centers. The standard first-line regimen remains cisplatin-based PEB (cisplatin, etoposide, bleomycin) combination chemotherapy, with EP (cisplatin, etoposide) or PEI (cisplatin, etoposide, ifosfamide) as alternatives in the case of bleomycin contraindication. Early treatment response, particularly tumor marker decline, is a key prognostic factor and may prompt treatment intensification. High-dose chemotherapy is the standard in the salvage setting; its role compared to conventional cisplatin, ifosfamide, and paclitaxel (TIP) chemotherapy is being prospectively evaluated in the international TIGER trial. Brain metastases are rare and usually managed with systemic therapy according to the poor-risk protocol, with surgery or stereotactic radiotherapy considered in selected cases. Early and late toxicities require consistent supportive care and structured long-term follow-up.