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Testicular Cancer Medication

  • Author: Kush Sachdeva, MD; Chief Editor: Jules E Harris, MD, FACP, FRCPC  more...
 
Updated: Jun 03, 2016
 

Medication Summary

Chemotherapy regimens for testicular cancers are divided into initial and salvage chemotherapy, according to tumor stage, status, and risk stratification.

Initial Chemotherapy Regimens

Carboplatin (for stage I seminoma)

Carboplatin area under the curve (AUC) 7 (see Carboplatin AUC Dose Calculation [Calvert Formula]) for one or two cycles

BEP (5-day schedule)

Bleomycin 30 U or 30 mg IV bolus day 1, 8, 15 or day 2, 9, 16

Etoposide (VP-16) 100 mg/m2/day IV for 5 days

Cisplatin (CDDP) 20 mg/m2/day IV for 5 days

This regimen is administered for three to four cycles at 21-day intervals

EP

Etoposide (VP-16) 100 mg/m2/day IV daily for 5 days

Cisplatin (CDDP) 20 mg/m2/day IV daily for 5 days

This regimen is administered for four cycles at 21-day intervals

VIP (for patients with underlying lung disease)

Etoposide (VP-16) 75 mg/m2/day IV daily for 5 days

Ifosfamide 1.2 g/m2/day IV daily for 5 days

Cisplatin (CDDP) 20 mg/m2/day IV for days 1-5

Mesna 120 mg/m2 slow IV bolus is given before ifosfamide day 1, followed by 1200 mg/m2/day continuous infusion on days 1-5

This regimen is administered for four cycles at 21-day intervals

Salvage Chemotherapy Regimens

VeIP (for patients who received prior etoposide)

Vinblastine 0.11 mg/kg/ IV daily for 2 days

Ifosfamide 1,200 mg/m2 IV daily for 5 days

Mesna 400 mg/m2 IV every 8 hours for 5 days

Cisplatin (CDDP) 20 mg/m2 IV daily for 5 days

This regimen is administered for four cycles at 21-day intervals

TIP

Paclitaxel 250 mg/m2 IV day 1 followed by ifosfamide 1500 mg/m2 IV daily days 2-5 and cisplatin (CDDP) 25 mg/m2 IV daily on days 2-5

Mesna 500 mg/m2 IV before ifosfamide, and then 4 and 8 hrs after each dose of ifosfamide daily on days 2-5

This regimen is administered for four cycles at 21-day intervals

GEMOX (palliative second-line)

Gemcitabine 1000 or 1250 mg/m2 IV on days 1 and 8, plus oxaliplatin 130 mg/m2 IV on day 1, administered every 3 weeks

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Antineoplastic Agent, Topoisomerase II Inhibitors

Class Summary

These agents may cause DNA strand breaks, which may result in the inhibition of cell growth and proliferation.

Etoposide (Toposar)

 

Glycosidic derivative of podophyllotoxin that exerts its cytotoxic effect through stabilization of the normally transient covalent intermediates formed between DNA substrate and topoisomerase II, leading to single- and double-strand DNA breaks. This causes cell proliferation to arrest in late S or early G2 portion of the cell cycle.

Therapy should be withheld or suspended if platelet counts are < 50,000 or absolute neutrophil counts are < 500/mm3. Reduce dose 20% for granulocytic fever or previous radiotherapy. Reduce dose in hepatic (increased total bilirubin [TB]) and renal (decreased CrCl) impairment.

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Antineoplastic Agent, Antibiotics

Class Summary

Agents in this class may cause single and double DNA strand breaks and may inhibit RNA and protein synthesis.

Bleomycin

 

Group of glycopeptides extracted from Streptomyces species. Each molecule has a planar end and an amine end; different glycopeptides of the group differ in their terminal amine moieties. Planar end intercalates with DNA, while amine end facilitates oxidation of bound ferrous ions to ferric ions, thereby generating free radicals, which subsequently cleave DNA, acting specifically at purine-G-C-pyrimidine sequences.

Not absorbed when given orally; peak levels reached in about 30-60 min when given IM and are only one third of levels obtained after IV administration; approximately 50% of drug absorbed systemically after intrapleural or intraperitoneal administration; systemic absorption after intracavitary administration for craniopharyngioma not negligible.

Volume of distribution is 20-30 L both in intracellular and extracellular fluid.

Less than 10% is bound to plasma proteins.

Bleomycin has plasma half-life of less than 1 h and terminal half-life of 2-4 h, but it could be as long as 22 h in patients with renal dysfunction or those previously treated with cisplatin.

About 50% eliminated in urine within 24 h. Most tissues (known exceptions—skin and lungs) contain an enzyme, bleomycin hydrolase (most active tissues are liver and kidney), which readily inactivates drug; therefore, toxicity is tissue specific, occurring in tissues lacking this enzyme. Bleomycin mostly used systemically in combination with other drugs (mostly with cisplatin and vincristine).

Principal mechanisms of resistance include high levels of bleomycin hydrolase, cell mutations altering DNA sequences to prevent intercalation, poor cell accumulation of drug, and rapid plasma removal. None of these factors plays important role when bleomycin administered locally in residual cyst.

Toxicity is age dependent and cumulative dose related; systemic administration mostly causes pulmonary toxicity. This consists of pneumonitis, which can progress to fatal pulmonary fibrosis.

Maximum recommended total cumulative dose for systemic use is 400 U. Unit measurement based on toxicity to bacteria; 1 U equals approximately 1.7 mg.

Administered systemically, does not produce significant bone marrow toxicity. Toxicity with local administration due to both systemic contamination (when anaphylactoid reactions, transient fever, nausea, and vomiting could occur) and leakage into surrounding neural tissue. Fatal outcome has been reported with leakage, due to subsequent diffuse diencephalon and brainstem edema.

Contrast CT cystography is required prior to intracavitary administration to ensure cyst wall integrity; when inconclusive, MR cystography with gadopentetate dimeglumine has been advocated.

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Antineoplastic Agent, Alkylating Agents

Class Summary

These agents may inhibit DNA synthesis and disrupt DNA function.

Cisplatin

 

Platinum-containing compound that exerts antineoplastic effect by covalently binding to DNA with preferential binding to N-7 position of guanine and adenosine. Can react with 2 different sites on DNA to cause cross-links. Platinum complex also can bind to nucleus and cytoplasmic protein. A bifunctional alkylating agent, once activated to aquated form in cell, binds to DNA, resulting in interstrand and intrastrand cross-linking and denaturation of double helix.

Modify dose on basis of CrCl. Avoid use if CrCl < 60 mL/min.

Ifosfamide (Ifex)

 

Alkylating agent activated in liver to phosphoramide mustard and acrolein. Phosphoramide mustard cross-links DNA strands and is responsible for therapeutic effect. Acrolein related to bladder toxicity.

Oxaliplatin (Eloxatin)

 

Platinum-based antineoplastic agent forms interstrand and intrastrand Pt-DNA crosslinks that inhibit DNA replication and transcription. Cytotoxicity is cell-cycle nonspecific.

Carboplatin

 

Analog of cisplatin. This is a heavy metal coordination complex that exerts its cytotoxic effect by platination of DNA, a mechanism analogous to alkylation, leading to interstrand and intrastrand DNA crosslinks and inhibition of DNA replication. Binds to protein and other compounds containing SH group. Cytotoxicity can occur at any stage of the cell cycle, but cell is most vulnerable to action of these drugs in G1 and S phase.

Has same efficacy as cisplatin but with better toxicity profile. Main advantages over cisplatin include less nephrotoxicity and ototoxicity not requiring extensive prehydration, less likely to induce nausea and vomiting, but more likely to induce myelotoxicity.

Dose is based on the following formula: total dose (mg) = (target AUC) x (GFR+25) where AUC (area under plasma concentration-time curve) is expressed in mg/mL/min and GFR (glomerular filtration rate) is expressed in mL/min.

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Antineoplastic Agents, Antimicrotubular

Class Summary

Agents in this class may distort mitotic spindles and result in breakage of chromosomes.

Paclitaxel

 

Mechanisms of action are tubulin polymerization and microtubule stabilization.

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Antineoplastic Agent, Vinca Alkaloids

Class Summary

These agents may inhibit microtubule formation.

Vinblastine

 

Vinca alkaloid, inhibits microtubule formation, which disrupts formation of mitotic spindle, causing cell proliferation to arrest at metaphase.

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Antineoplastic Agent, Antimetabolites

Class Summary

Agents in this class are pyrimidine antimetabolites that inhibit DNA synthesis.

Gemcitabine (Gemzar)

 

Cytidine analog, after intracellular metabolism to active nucleotide, inhibits ribonucleotide reductase and competes with deoxycytidine triphosphate for incorporation into DNA. Cell-cycle specific for S phase.

This drug has been shown to have activity in a phase 2 trial against relapsed germ cell tumors.

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Antidote, Cyclosphosphamide-induced Hemorrhagic Cystitis

Class Summary

Agents in this class may inactivate acrolein, the urotoxic metabolite from ifosfamide and cyclophosphamide.

Mesna (Mesnex)

 

Inactivates acrolein and prevents urothelial toxicity without affecting cytostatic activity.

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Contributor Information and Disclosures
Author

Kush Sachdeva, MD Southern Oncology and Hematology Associates, South Jersey Healthcare, Fox Chase Cancer Center Partner

Disclosure: Nothing to disclose.

Coauthor(s)

Brendan Curti, MD Director, Genitourinary Oncology Research, Robert W Franz Cancer Research Center, Earle A Chiles Research Institute, Providence Cancer Center

Brendan Curti, MD is a member of the following medical societies: American College of Physicians, American Society of Clinical Oncology, Oregon Medical Association, Society for Immunotherapy of Cancer

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Prometheus Pharmaceuticals<br/>Received research grant from: Prometheus Pharmaceuticals.

Issam Makhoul, MD Associate Professor, Department of Medicine, Division of Hematology/Oncology, University of Arkansas for Medical Sciences

Issam Makhoul, MD is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology

Disclosure: Nothing to disclose.

Mansoor Javeed, MD, FACP Clinical Assistant Professor of Medicine, University of California, Davis, School of Medicine; Consultant, Sierra Hematology-Oncology Medical Center

Mansoor Javeed, MD, FACP is a member of the following medical societies: American College of Physicians, Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Bagi RP Jana, MD Associate Professor of Medicine (Genitourinary Oncology), Division of Hematology and Oncology, University of Texas Medical Branch

Bagi RP Jana, MD is a member of the following medical societies: American Cancer Society, American Medical Association, SWOG, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Jules E Harris, MD, FACP, FRCPC Clinical Professor of Medicine, Section of Hematology/Oncology, University of Arizona College of Medicine, Arizona Cancer Center

Jules E Harris, MD, FACP, FRCPC is a member of the following medical societies: American Association for the Advancement of Science, American Society of Hematology, Central Society for Clinical and Translational Research, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Additional Contributors

Philip Schulman, MD Chief, Medical Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center

Philip Schulman, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, American Society of Hematology, Medical Society of the State of New York

Disclosure: Nothing to disclose.

Acknowledgements

The author and editors wish to thank Salah Almokadem, MD,  Assistant Professor of Medicine, Department of Medicine, Penn State Milton S Hershey Medical Center; and Charles J Ryan, MD, Assistant Clinical Professor, Department of Medicine, Division of Hematology and Oncology, University of California at San Francisco, for their contributions to previous versions of this article.

References
  1. American Cancer Society. Cancer Facts & Figures 2016. Available at http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf. Accessed: June 1, 2016.

  2. American Cancer Society. What are the key statistics about testicular cancer?. American Cancer Society. Available at http://www.cancer.org/cancer/testicularcancer/detailedguide/testicular-cancer-key-statistics. Accessed: June 1, 2016.

  3. Testicular Cancer Treatment. National Cancer Institute. Available at http://www.cancer.gov/cancertopics/pdq/treatment/testicular/HealthProfessional/page1. February 17, 2016; Accessed: June 1, 2016.

  4. McGlynn KA, Devesa SS, Sigurdson AJ, Brown LM, Tsao L, Tarone RE. Trends in the incidence of testicular germ cell tumors in the United States. Cancer. 2003 Jan 1. 97(1):63-70. [Medline].

  5. Surveillance, Epidemiology, and End Results Program. SEER Stat Fact Sheets: Testis Cancer. National Cancer Institute. Available at http://seer.cancer.gov/statfacts/html/testis.html. Accessed: June 1, 2016.

  6. Trabert B, Chen J, Devesa SS, Bray F, McGlynn KA. International patterns and trends in testicular cancer incidence, overall and by histologic subtype, 1973-2007. Andrology. 2014 Oct 20. [Medline].

  7. Chia VM, Quraishi SM, Devesa SS, Purdue MP, Cook MB, McGlynn KA. International trends in the incidence of testicular cancer, 1973-2002. Cancer Epidemiol Biomarkers Prev. 2010 May. 19(5):1151-9. [Medline]. [Full Text].

  8. McGlynn KA, Devesa SS, Graubard BI, Castle PE. Increasing incidence of testicular germ cell tumors among black men in the United States. J Clin Oncol. 2005 Aug 20. 23(24):5757-61. [Medline].

  9. Chien FL, Schwartz SM, Johnson RH. Increase in testicular germ cell tumor incidence among Hispanic adolescents and young adults in the United States. Cancer. 2014 Sep 1. 120(17):2728-34. [Medline].

  10. Pettersson A, Richiardi L, Nordenskjold A, Kaijser M, Akre O. Age at surgery for undescended testis and risk of testicular cancer. N Engl J Med. 2007 May 3. 356(18):1835-41. [Medline].

  11. Travis LB, Fossa SD, Schonfeld SJ, McMaster ML, Lynch CF, Storm H. Second cancers among 40,576 testicular cancer patients: focus on long-term survivors. J Natl Cancer Inst. 2005 Sep 21. 97(18):1354-65. [Medline].

  12. van Leeuwen FE, Stiggelbout AM, van den Belt-Dusebout AW, et al. Second cancer risk following testicular cancer: a follow-up study of 1,909 patients. J Clin Oncol. 1993 Mar. 11(3):415-24. [Medline].

  13. Walsh TJ, Croughan MS, Schembri M, Chan JM, Turek PJ. Increased risk of testicular germ cell cancer among infertile men. Arch Intern Med. 2009 Feb 23. 169(4):351-6. [Medline].

  14. [Guideline] Testicular Cancer: Version 2.2016. National Comprehensive Cancer Network. Available at http://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf. Accessed: June 2, 2016.

  15. Subik MK, Gordetsky J, Yao JL, di Sant'agnese PA, Miyamoto H. Frozen section assessment in testicular and paratesticular lesions suspicious for malignancy: its role in preventing unnecessary orchiectomy. Hum Pathol. 2012 Mar 8. [Medline].

  16. American Joint Committee on Cancer. Testis. AJCC Cancer Staging Manual. 6th edition. New York: Springer Science Business Media LCC; 2006.

  17. International Germ Cell Cancer Collaborative Group. International Germ Cell Consensus Classification: a prognostic factor- based staging system for metastatic germ cell cancers. J Clin Oncol. 1997 Feb. 15(2):594-603. [Medline].

  18. Kollmannsberger C, Tyldesley S, Moore C, et al. Evolution in management of testicular seminoma: population-based outcomes with selective utilization of active therapies. Ann Oncol. 2011 Apr. 22(4):808-14. [Medline].

  19. Mead GM, Fossa SD, Oliver RT, Joffe JK, Huddart RA, Roberts JT, et al. Randomized Trials in 2466 Patients With Stage I Seminoma: Patterns of Relapse and Follow-up. J Natl Cancer Inst. 2011 Feb 2. 103(3):241-249. [Medline].

  20. Oliver RT, Mason MD, Mead GM, von der Maase H, Rustin GJ, Joffe JK. Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial. Lancet. 2005 Jul 23-29. 366(9482):293-300. [Medline].

  21. Oliver RT, Mead GM, Fogarty PJ, Stenning SP, MRC TE19 and EORTC 30982 trial collaborators. Radiotherapy versus carboplatin for stage I seminoma: Updated analysis of the MRC/EORTC randomized trial (ISRCTN27163214). J Clin Oncol. May 20 2008. 26 suppl:abstract 1. [Full Text].

  22. De Santis M, Becherer A, Bokemeyer C, Stoiber F, Oechsle K, Sellner F. 2-18fluoro-deoxy-D-glucose positron emission tomography is a reliable predictor for viable tumor in postchemotherapy seminoma: an update of the prospective multicentric SEMPET trial. J Clin Oncol. 2004 Mar 15. 22(6):1034-9. [Medline].

  23. Daugaard G, Gundgaard MG, Mortensen MS, Agerbæk M, Holm NV, et al. Surveillance for stage I nonseminoma testicular cancer: outcomes and long-term follow-up in a population-based cohort. J Clin Oncol. 2014 Dec 1. 32(34):3817-23. [Medline].

  24. Einhorn LH, Williams SD, Chamness A, Brames MJ, Perkins SM, Abonour R. High-dose chemotherapy and stem-cell rescue for metastatic germ-cell tumors. N Engl J Med. 2007 Jul 26. 357(4):340-8. [Medline].

  25. Pectasides D, Pectasides M, Farmakis D, Aravantinos G, Nikolaou M, Koumpou M. Gemcitabine and oxaliplatin (GEMOX) in patients with cisplatin-refractory germ cell tumors: a phase II study. Ann Oncol. 2004 Mar. 15(3):493-7. [Medline].

  26. Jeruss JS, Woodruff TK. Preservation of fertility in patients with cancer. N Engl J Med. 2009 Feb 26. 360(9):902-11. [Medline].

  27. Haugnes HS, Aass N, Fosså SD, Dahl O, Brydøy M, Aasebø U, et al. Pulmonary function in long-term survivors of testicular cancer. J Clin Oncol. 2009 Jun 10. 27 (17):2779-86. [Medline]. [Full Text].

  28. Willemse PM, Hamdy NA, de Kam ML, Burggraaf J, Osanto S. Changes in Bone Mineral Density in Newly Diagnosed Testicular Cancer Patients After Anti-cancer treatment. J Clin Endocrinol Metab. 2014 Aug 13. jc20141722. [Medline].

  29. van Dijk MR, Steyerberg EW, Habbema JD. Survival of non-seminomatous germ cell cancer patients according to the IGCC classification: An update based on meta-analysis. Eur J Cancer. 2006 May. 42(7):820-6. [Medline].

  30. Albers P, Siener R, Krege S, Schmelz HU, Dieckmann KP, Heidenreich A. Randomized phase III trial comparing retroperitoneal lymph node dissection with one course of bleomycin and etoposide plus cisplatin chemotherapy in the adjuvant treatment of clinical stage I Nonseminomatous testicular germ cell tumors: AUO trial AH 01/94 by the German Testicular Cancer Study Group. J Clin Oncol. 2008 Jun 20. 26(18):2966-72. [Medline].

  31. Albqami N, Janetschek G. Laparoscopic retroperitoneal lymph-node dissection in the management of clinical stage I and II testicular cancer. J Endourol. 2005 Jul-Aug. 19(6):683-92; discussion 692. [Medline].

  32. Aparicio J, Germa JR, Garcia del Muro X, Maroto P, Arranz JA, Saenz A. Risk-adapted management for patients with clinical stage I seminoma: the Second Spanish Germ Cell Cancer Cooperative Group study. J Clin Oncol. 2005 Dec 1. 23(34):8717-23. [Medline].

  33. Beck SD, Foster RS, Bihrle R, Cheng L, Donohue JP. Does the histology of nodal metastasis predict systemic relapse after retroperitoneal lymph node dissection in pathological stage B1 germ cell tumors?. J Urol. 2005 Oct. 174(4 Pt 1):1287-90; discussion 1290. [Medline].

  34. Beck SD, Foster RS, Bihrle R, Cheng L, Ulbright TM, Donohue JP. Impact of the number of positive lymph nodes on disease-free survival in patients with pathological stage B1 nonseminomatous germ cell tumor. J Urol. 2005 Jul. 174(1):143-5. [Medline].

  35. Bokemeyer C. Bleomycin in testicular cancer: will pharmacogenomics improve treatment regimens?. J Clin Oncol. 2008 Apr 10. 26(11):1783-5. [Medline].

  36. Chaganti RS, Houldsworth J. Genetics and biology of adult human male germ cell tumors. Cancer Res. 2000 Mar 15. 60(6):1475-82. [Medline].

  37. Chung PW, Warde PR, Panzarella T, Bayley AJ, Catton CN, Milosevic MF. Appropriate radiation volume for stage IIA/B testicular seminoma. Int J Radiat Oncol Biol Phys. 2003 Jul 1. 56(3):746-8. [Medline].

  38. Classen J, Schmidberger H, Meisner C, Souchon R, Sautter-Bihl ML, Sauer R. Radiotherapy for stages IIA/B testicular seminoma: final report of a prospective multicenter clinical trial. J Clin Oncol. 2003 Mar 15. 21(6):1101-6. [Medline].

  39. Classen J, Schmidberger H, Meisner C, Winkler C, Dunst J, Souchon R. Para-aortic irradiation for stage I testicular seminoma: results of a prospective study in 675 patients. A trial of the German testicular cancer study group (GTCSG). Br J Cancer. 2004 Jun 14. 90(12):2305-11. [Medline].

  40. Culine S, Kramar A, Théodore C, Geoffrois L, Chevreau C, Biron P. Randomized trial comparing bleomycin/etoposide/cisplatin with alternating cisplatin/cyclophosphamide/doxorubicin and vinblastine/bleomycin regimens of chemotherapy for patients with intermediate- and poor-risk metastatic nonseminomatous germ cell tumors: Genito-Urinary Group of the French Federation of Cancer Centers Trial T93MP. J Clin Oncol. 2008 Jan 20. 26(3):421-7. [Medline].

  41. Daugaard G, Petersen PM, Rørth M. Surveillance in stage I testicular cancer. APMIS. 2003 Jan. 111(1):76-83; discussion 83-5. [Medline].

  42. De Giorgi U, Rosti G, Aieta M, Testore F, Burattini L, Fornarini G. Phase II study of oxaliplatin and gemcitabine salvage chemotherapy in patients with cisplatin-refractory nonseminomatous germ cell tumor. Eur Urol. 2006 Nov. 50(5):1032-8; discussion 1038-9. [Medline].

  43. de Wit R. Optimal management of retroperitoneal metastatic nonseminomatous testicular cancer: toward a better selection between scalpel and needle. J Clin Oncol. 2007 Dec 10. 25(35):5550-2. [Medline].

  44. de Wit R, Roberts JT, Wilkinson PM, et al. Equivalence of three or four cycles of bleomycin, etoposide, and cisplatin chemotherapy and of a 3- or 5-day schedule in good-prognosis germ cell cancer: a randomized study of the European Organization for Research and Treatment of Cancer Genitourinary Tract Cancer Cooperative Group and the Medical Research Council. J Clin Oncol. 2001 Mar 15. 19(6):1629-40. [Medline].

  45. Feldman DR, Bosl GJ, Sheinfeld J, Motzer RJ. Medical treatment of advanced testicular cancer. JAMA. 2008 Feb 13. 299(6):672-84. [Medline].

  46. Haugnes HS, Aass N, Fossa SD, et al. Pulmonary function in long-term survivors of testicular cancer. J Clin Oncol. 2009 Jun 10. 27(17):2779-86. [Medline].

  47. Hinton S, Catalano PJ, Einhorn LH, Nichols CR, David Crawford E, Vogelzang N. Cisplatin, etoposide and either bleomycin or ifosfamide in the treatment of disseminated germ cell tumors: final analysis of an intergroup trial. Cancer. 2003 Apr 15. 97(8):1869-75. [Medline].

  48. Holm M, Hoei-Hansen CE, Rajpert-De Meyts E, Skakkebaek NE. Increased risk of carcinoma in situ in patients with testicular germ cell cancer with ultrasonic microlithiasis in the contralateral testicle. J Urol. 2003 Oct. 170(4 Pt 1):1163-7. [Medline].

  49. Horvath A, Korde L, Greene MH, Libe R, Osorio P, Faucz FR, et al. Functional phosphodiesterase 11A mutations may modify the risk of familial and bilateral testicular germ cell tumors. Cancer Res. 2009 Jul 1. 69(13):5301-6. [Medline]. [Full Text].

  50. Houck W, Abonour R, Vance G, Einhorn LH. Secondary leukemias in refractory germ cell tumor patients undergoing autologous stem-cell transplantation using high-dose etoposide. J Clin Oncol. 2004 Jun 1. 22(11):2155-8. [Medline].

  51. Jones WG, Fossa SD, Mead GM, Roberts JT, Sokal M, Horwich A. Randomized trial of 30 versus 20 Gy in the adjuvant treatment of stage I Testicular Seminoma: a report on Medical Research Council Trial TE18, European Organisation for the Research and Treatment of Cancer Trial 30942 (ISRCTN18525328). J Clin Oncol. 2005 Feb 20. 23(6):1200-8. [Medline].

  52. Kollmannsberger C, Beyer J, Liersch R, Schoeffski P, Metzner B, Hartmann JT. Combination chemotherapy with gemcitabine plus oxaliplatin in patients with intensively pretreated or refractory germ cell cancer: a study of the German Testicular Cancer Study Group. J Clin Oncol. 2004 Jan 1. 22(1):108-14. [Medline].

  53. Kollmannsberger C, Beyer J, Liersch R, Schoeffski P, Metzner B, Hartmann JT. Combination chemotherapy with gemcitabine plus oxaliplatin in patients with intensively pretreated or refractory germ cell cancer: a study of the German Testicular Cancer Study Group. J Clin Oncol. 2004 Jan 1. 22(1):108-14. [Medline].

  54. Kondagunta GV, Bacik J, Bajorin D, Dobrzynski D, Sheinfeld J, Motzer RJ. Etoposide and cisplatin chemotherapy for metastatic good-risk germ cell tumors. J Clin Oncol. 2005 Dec 20. 23(36):9290-4. [Medline].

  55. Kondagunta GV, Bacik J, Donadio A, Bajorin D, Marion S, Sheinfeld J. Combination of paclitaxel, ifosfamide, and cisplatin is an effective second-line therapy for patients with relapsed testicular germ cell tumors. J Clin Oncol. 2005 Sep 20. 23(27):6549-55. [Medline].

  56. Melchior D, Muller SC, Albers P. Extensive surgery in metastatic testicular cancer. Aktuelle Urol. 2003 Jul. 34(4):214-22. [Medline].

  57. Motzer RJ, Rodriguez E, Reuter VE, et al. Molecular and cytogenetic studies in the diagnosis of patients with poorly differentiated carcinomas of unknown primary site. J Clin Oncol. 1995 Jan. 13(1):274-82. [Medline].

  58. R. T. Oliver, G. M. Mead, P. J. Fogarty, S. P. Stenning, MRC TE19 and EORTC 30982 trial collaborators. Radiotherapy versus carboplatin for stage I seminoma: Updated analysis of the MRC/EORTC randomized trial (ISRCTN27163214). J Clin Oncol. 2008. 26:(May 20 suppl; abstr 1).

  59. Rick O, Bokemeyer C, Weinknecht S, Schirren J, Pottek T, Hartmann JT. Residual tumor resection after high-dose chemotherapy in patients with relapsed or refractory germ cell cancer. J Clin Oncol. 2004 Sep 15. 22(18):3713-9. [Medline].

  60. Shamash J, Stebbing J, Powles T. Germ-cell tumors. N Engl J Med. 2007 Oct 25. 357(17):1771-2; author reply 1773-4. [Medline].

  61. Sheinfeld J, Motzer RJ. Stage I testicular cancer management and necessity for surgical expertise. J Clin Oncol. 2008 Jun 20. 26(18):2934-6. [Medline].

  62. Tandstad T, Dahl O, Cohn-Cedermark G, Cavallin-Stahl E, Stierner U, Solberg A. Risk-adapted treatment in clinical stage I nonseminomatous germ cell testicular cancer: the SWENOTECA management program. J Clin Oncol. 2009 May 1. 27(13):2122-8. [Medline].

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Table. Incidence of Testicular Cancer by Race
Incidence of Testicular Cancer by Race
Race/EthnicityAnnual rate per 100,000 men
All Races5.7
White6.7
Black1.5
Asian/Pacific Islander2.1
American Indian/Alaska Native4.9
Hispanic5.0
Table 1. Serum Tumor Markers
    
StageLDHHCG (mIU/mL)AFP (ng/mL)
    
S1< 1.5 times normal< 5,000< 1,000
S21.5-10 times normal5,000-50,0001,000-10,000
S3>10 times normal>50,000>10,000
LDH=lactate dehydrogenase; HCG=beta human chorionic gonadotropin; AFP=alpha fetoprotein. 
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