eMedicine Specialties > Oncology > Carcinomas of the Genitourinary Tract
Testicular Cancer: Treatment & Medication
Updated: Jul 29, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
Testicular cancers are curable even in the presence of metastatic disease. If the cancer progresses or recurs despite initial chemotherapy, these patients are candidates for salvage therapy.
Nonseminoma is more aggressive than seminoma. When the elements of both seminoma and nonseminoma are present or the AFP concentration is elevated, the tumor should be treated as a nonseminoma.
Initial therapy is selected according to AJCC stage group; risk stratification (good, intermediate, or poor risk), as per the guidelines of the International Germ Cell Cancer Collaborative Group7 ; and histology (seminoma versus nonseminoma).
Current guidelines from the National Comprehensive Cancer Network (NCCN) and the National Cancer Institute recommend treatment approach keyed to AJCC staging. These treatment groups are as follows:
- Seminoma stage IA, IB
- Seminoma stage IS
- Seminoma stage IIA, IIB
- Seminoma stage IIC, III
- Nonseminoma stage IA, IB, IS
- Nonseminoma stage IIA, IIB
- Nonseminoma stage IIC, IIIA, IIIB, IIIC and brain metastases
- Recurrent disease and salvage treatment
Clinical stage I seminoma have a very high cure rate. Cure can sometimes be achieved by radical inguinal orchiectomy alone. Options after orchiectomy include active surveillance, adjuvant chemotherapy, and adjuvant radiation therapy. Median time to relapse in patients who do not receive adjuvant treatment is 12 months but relapse can occur even beyond 5 years.
- Active surveillance is recommended for patients with horseshoe or pelvic kidney or inflammatory bowel disease and for those who have received prior radiotherapy. Surveillance can also be offered to selected patients with T1 or T2 disease. Surveillance consists of a history and physical exam and measurement of AFP and hCG every 3 to 4 months for the first 3 years, every 6 months for years 4 to 7, then annually up to year 10. A CT scan of the abdomen and pelvis is recommended at each visit and a chest x-ray at alternate visits. It is essential that patients maintain strict adherence to the surveillance program for at least 10 years.
- Adjuvant radiation therapy consists of delivery of 20-30 Gy to the infradiaphragmatic area, including the para-aortic lymph nodes and in some cases the ipsilateral ileoinguinal nodes. According to surveillance data, the overall incidence of disease failure without radiation therapy is 15% to 27%, with median of 20%. With radiation therapy, failure rates were 2% to 5%, with a median of 3%.
- Adjuvant chemotherapy with a single dose of carboplatin (see Medication) is currently recommended as an alternative to radiation therapy. In a randomized study in 1,477 patients, after a median followup of 4 years there was no difference in relapse-free survival between patients receiving single-dose carboplatin and those receiving radiation therapy.8 Five-year followup in 1,148 patients from this trial showed relapse-free rates of 96% for the radiation arm and 94.7% for the carboplatin arm. However, there were 15 new germ cell tumors in the radiation therapy arm versus two in the carboplatin arm, giving a hazard radio of 0.22 (95% CI 0.05, 0.95 p = 0.33).9 Acute toxicity such as lethargy and days missed from work was less with carboplatin than with radiation therapy.
- Adjuvant radiation therapy, 20-30 Gy, is administered to the infradiaphragmatic area, including para-aortic lymph nodes, with or without ipsilateral ileoinguinal nodes.
Seminoma stage IIA and IIB
Active surveillance is not an option. These patients receive adjuvant chemotherapy or radiation therapy.
- Radiation therapy: 35-40Gy is administered to the infradiaphragmatic area, including the para-aortic and ipsilateral iliac lymph nodes. Mediastinal radiation is not recommended.
- Adjuvant chemotherapy: Four courses of chemotherapy with etoposide and cisplatin (EP) may be given .
Stage IIC and III seminomas are categorized as good risk or intermediate risk. Intermediate risk seminomas include nonpulmonary visceral metastatic disease. Chemotherapy is the option for both groups, with different regimens for the two categories.
- Seminoma stage IIC and III, good risk: Either four cycles of EP or three cycles of bleomycin, etoposide, and cisplatin (BEP)
- Seminoma stage IIC and III, intermediate risk: Four cycles of BEP
For stage II and III seminoma after primary treatment with chemotherapy, recommended surveillance includes CT scans of the chest, abdomen, and pelvis along with serum tumor marker assays.
- No disease: surveillance is recommended.
- Residual mass with normal markers: Consider PET scanning. In some cases of seminoma, a PET scan may detect nodal and extranodal disease that is not evident on CT scans.10 PET scans for evaluating the response of chemotherapy in seminoma should be performed 3-4 weeks after the last course of chemotherapy. If the PET scan is negative, surveillance is recommended. Options for patients with a positive PET scan include surgery with biopsy or biopsy and salvage chemotherapy or radiation therapy. If a PET scan cannot be done and the residual mass is 3 cm or less in size, surveillance is recommended. When the mass is larger than 3 cm in size, surveillance could be considered but surgery and radiation therapy are options and should be discussed with the patient.
- Progressive disease with a growing mass or rising marker levels: salvage chemotherapy
After radical inguinal orchiectomy, treatment options are active surveillance or chemotherapy. Retroperitoneal lymph node dissection (RPLND) is used to guide chemotherapy; the number of positive nodes present in the sample determines the number of chemotherapy cycles given. Open nerve-sparing RPLND is preferred over laparoscopic RPLND. RPLND has multiple complications of with (RPLND), including retrograde ejaculation.
- Nonseminoma stage IA: Active surveillance can be used in compliant patients. The Surveillance should include an abdominal and pelvic CT scan every 2-3 months for the first year and every 3-4 months in the second year; history and physical examination, chest x-ray, and tumor marker assays should be done every 1-2 months for the first year and every 2 months during the second year. The cure rate is 95%. Adherence to the surveillance program is the key to success. Noncompliant patient should be offered RPLND within 4 weeks of the CT scan. If RPLND results are negative, no adjuvant chemotherapy is recommended. If RPLND results are positive, adjuvant chemotherapy is recommended.
- Nonseminoma stage IB: Options are open nerve-sparing RPLND; chemotherapy with BEP for 2 cycles; or active surveillance for compliant patients who have T2 disease without any vascular invasion.
- Nonseminoma stage IS: If persistent tumor marker elevation is present but no abnormality is visible on imaging studies, chemotherapy with EP for 4 cycles or BEP for 3 cycles is recommended.
Recommended treatment varies according to the results of tumor marker assays and CT scan.
- Nonseminoma stage IIA with normal tumor markers: open nerve-sparing RPLND or chemotherapy, either EP for 4 cycles or BEP for 3 cycles.
- Nonseminoma stage IIA with persistent elevation of tumor markers: chemotherapy, either EP for 4 cycles or BEP for 3 cycles.
- Nonseminoma stage IIB with normal tumor markers and lymph node metastasis within lymphatic drainage site by CT scan: open nerve-sparing RPLND or chemotherapy, either EP for 4 cycles or BEP for 3 cycles.
- Nonseminoma stage IIB normal tumor markers and multifocal symptomatic lymph node metastases with aberrant lymphatic drainage by CT scan: chemotherapy, either EP for 4 cycles or BEP for 3 cycles.
- Nonseminoma stage IIB with persistent elevation of tumor markers: chemotherapy, either EP for 4 cycles or BEP for 3 cycles.
Patients with stage IIC and III are treated with chemotherapy, with the regimen choice based on risk status. Approximately 20-30% of patients with metastatic testicular cancer cannot be cured.
- Nonseminoma stage IIC, IIIA good risk: 95% of patients are cured with chemotherapy, either EP for 4 cycles or BEP for 3 cycles.
- Nonseminoma stage IIIB intermediate risk: BEP for 4 cycles is given; the cure rate is 70%.
- Nonseminoma stage IIIB poor risk: Enrollment in clinical trials is preferred. Chemotherapy with 4 cycles with BEP can be considered but fewer than 50% of patients will experience a durable complete response. In patients who cannot tolerate BEP because of pneumonitis from the bleomycin component, VIP (etoposide [VePesid], ifosfamide, mesna, cisplatin [Platinol-AQ]) is recommended.
- Brain metastases: Primary chemotherapy plus radiation. Surgery should be performed if clinically indicated.
- Nonseminoma stage IIC, IIIA, IIIB, IIIC post-chemotherapy management: CT scan of the abdomen and pelvis and tumor marker assays are indicated after the completion of chemotherapy. With patients in whom these tests indicate a complete response, options are surveillance or open nerve-sparing RPLND. If residual disease is present but tumor marker levels are normal, all the residual disease should be resected. If the resection specimen shows only necrotic tissue or teratoma, no further therapy is recommended and active surveillance should be done. If residual embryonal, yolk sac, choriocarcinoma, or seminoma elements are present, the patient should receive 2 cycles of chemotherapy with EP, TIP (paclitaxel, ifosfamide and cisplatin), VIP, or VeIP (vinblastine, ifosfamide, mesna, cisplatin). Patients who do not have a complete response to chemotherapy and/or whose disease cannot be resected should receive salvage chemotherapy.
Recurrent disease and salvage treatment
Patients who do not have a complete response to first-line therapy, or whose disease recurs after complete response, are categorized into favorable and unfavorable prognostic groups.
- Salvage treatment for patients with a favorable prognosis: This group includes patients with low tumor marker levels, low-volume disease, complete response to first-line chemotherapy, and testis primary. These patients are treated with chemotherapy — VeIP or TIP. If they have an incomplete response or relapse, they should be considered for high-dose chemotherapy with autologous stem cell transplantation or enrollment in a clinical trial. In patients with a solitary metastatic site, salvage surgery should be considered. Patients who have a complete response should be followed closely and if they experience relapse, should be considered for clinical trials or high-dose chemotherapy.
- Salvage treatment for patients with an unfavorable prognosis: This group includes patients with an incomplete response to first-line chemotherapy, high tumor marker levels, high-volume disease, extratesticular primary, and late relapse. In these patients, enrollment in a clinical trial is preferred. Other options include high-dose chemotherapy plus autologous stem cell support, conventional chemotherapy with either VeIP or TIP, or best supportive care. Third-line chemotherapy with or without cyclophosphamide/ifosfamide can produce a durable complete response in 15-20% of patients and should be considered for patients with good performance scores.
- High-dose chemotherapy and stem cell rescue: High-dose chemotherapy with tandem courses of carboplatin and etoposide followed by hematopoietic stem cell rescue can produce complete remission in 5-10% of cisplatin-refractory testicular cancers.11 Non – cisplatin refractory testicular cancers have much better responses; more than 60% of these patients can be cured with high-dose chemotherapy.
- Palliative chemotherapy and radiation: Most patients who do not respond to high-dose chemotherapy probably have incurable disease; an exception is those with solitary metastatic disease that is surgically resectable. If surgery cannot be done, these patients can be considered for palliative chemotherapy or palliative radiation therapy. Gemcitabine and oxaliplatin (GEMOX) has shown efficacy in relapsed cisplatin-refractory disease and may offer a chance for long-term survival.12
Surgical Care
Surgical resection is recommended for patients with residual disease after chemotherapy. Retroperitoneal lymph node dissection (RPLND) should clear the region of residual disease. Open nerve-sparing RPLND is preferred over laparoscopic RPLND. Patients in whom RPLND reveals viable cancer (in approximately 60% of patients, postchemotherapy residual masses are either viable cancer or teratoma) are treated with subsequent chemotherapy. Open nerve-sparing RPLND has multiple complications, including retrograde ejaculation and other infertility issues.
Consultations
Fertility and sperm banking
Because 45% to 55% of testicular cancer patients have azoospermia or oligospermia at or beyond 2 years after therapy, those patients who wish to preserve fertility should be offered semen cryopreservation before the start of therapy.13 Some experts recommend performing a baseline sperm count and sperm banking prior to the radiographic diagnostic evaluation, to avoid radiation exposure of the sperm. An increased rate of fetal malformations has not been reported in the subsequent offspring of men who have retained fertility after treatment for testicular cancer.
Medication
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 AUC 7 x 1 cycle or 2 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 five days
Cisplatin (CDDP) 20 mg/m2/day IV for five days
This regimen is administered for 3 to 4 cycles at 21-day intervals
EP
Etoposide (VP-16) 100 mg/m2/day IV daily for five days
Cisplatin (CDDP) 20 mg/m2/day IV daily for five days
This regimen is administered for 4 cycles at 21-day intervals
VIP (for patients with underlying lung disease)
Etoposide (VP-16) 75 mg/m2/day IV daily for five days
Ifosfamide 1.2 g/m2/day IV daily for five days
Cisplatin (CDDP) 20 mg/m2/day IV for days one through five
Mesna 120 mg/m2 slow IV bolus is given before ifosfamide day one, followed by 1,200 mg/m2/day continuous infusion on days one through five
This regimen is administered for 4 cycles at 21-day intervals
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 five days
Mesna 400 mg/m2 IV every 8 hours for 5 days
Cisplatin (CDDP) 20 mg/m2 IV daily for five days
This regimen is administered for 4 cycles at 21-day intervals
TIP
Paclitaxel 250 mg/m2 IV day one followed by Ifosfamide 1500mg/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 4 cycles at 21-day intervals
GEMOX (palliative second line)
Gemcitabine 1,000 or 1,250 mg/m2 IV on days 1 and 8, plus oxaliplatin 130 mg/m2 IV on day 1 administered every 3 weeks
Antineoplastic Agent, Irritant
Etoposide
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.
Adult
100 mg/m2/d IV for 5 d; repeat q21d for 4 cycles; adjust dose in hepatic or renal dysfunction
TB 1.5-3 mg/dL: 50% dose reduction
TB 3.1-4.9 mg/dL: 75% dose reduction
TB >5 mg/dL: Avoid use
CrCl 15-50 mL/min: 25% dose reduction
Pediatric
Not established
May prolong the effects of warfarin and increase the clearance of methotrexate; cyclosporine and etoposide have additive effects in the cytotoxicity of tumor cells
Documented hypersensitivity; significant hypotension; IT administration may cause death
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Bleeding and severe myelosuppression may occur
Antineoplastic Agent, Antibiotic
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.
Adult
Test dose (optional): 1-2 U IV/IM prior to full dose
30 U IV bolus every wk on days 2, 9, and 16; repeat q21d for 4 cycles; modify dose based on CrCl
CrCl 20-30 mL/min: 50% of normal dose
CrCl <20 mL/min: 40% of normal dose
Pediatric
Not established
May decrease plasma levels of digoxin and phenytoin; cisplatin may increase toxicity of bleomycin when administered systemically
Documented hypersensitivity; significant renal function impairment; compromised pulmonary function
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in renal impairment; possibly secreted in breast milk; may cause mutagenesis and pulmonary toxicity (10%); idiosyncratic reactions similar to anaphylaxis (1%), may occur; monitor for adverse effects during and after treatment; vaso-occlusive phenomenon with distal necrosis of digit; permanent damage to nail matrix may occur
Antineoplastic Agent, Alkylating Agent
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.
Adult
20 mg/m2/d IV over 20-60 min for 5 d; repeat q21d for 4 cycles
Pediatric
Not established
Increases toxicity of bleomycin and ethacrynic acid
Documented hypersensitivity, pre-existing renal insufficiency, myelosuppression, and hearing impairment
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Administer adequate hydration before and 24 h after cisplatin dosing to reduce risk of nephrotoxicity; myelosuppression, ototoxicity, nausea and vomiting, may occur
Ifosfamide
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.
Adult
1200 mg/m2/d IV continuous infusion on days 1-5; repeat q21d for 4 cycles
Pediatric
Not established
Phenobarbital, phenytoin, chloral hydrate, and other drugs that interfere with cytochrome P-450 activity, may alter effects of ifosfamide
Documented hypersensitivity; depressed bone marrow function
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
May cause hemorrhagic cystitis and severe myelosuppression; caution in renal function impairment or compromised bone marrow reserve
Oxaliplatin
Platinum-based antineoplastic agent forms interstrand and intrastrand Pt-DNA crosslinks that inhibit DNA replication and transcription. Cytotoxicity is cell-cycle nonspecific.
Adult
Oxaliplatin 130mg/m2 IV on day one with Gemcitabine administered every three wks
Pediatric
Not established
Documented hypersensitivity to oxaliplatin or other platinum compounds
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Anaphylaxis may occur within minutes of administration; may cause neuropathy, pulmonary fibrosis, bone marrow suppression, GI tract symptoms (eg, nausea, vomiting, stomatitis), renal or hepatic toxicity (decrease dose), or thromboembolism; dilute IV only in dextrose-containing solution
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.
Adult
AUC 7
Pediatric
600 mg/m2 IV on day 2 of therapy, or the following formula has been used in clinical trials: 6 X (uncorrected GFR + [15 X surface area])
Nephrotoxicity increases with aminoglycosides and other nephrotoxic drugs
Documented hypersensitivity; bone marrow suppression
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Monitor bone marrow function
Antineoplastic Agent, Antimicrotubular
Paclitaxel
Mechanisms of action are tubulin polymerization and microtubule stabilization.
Adult
250 mg/m2 IV over 24 h q3wk
Pediatric
200 mg/m2 IV infused over 24 hours has been used in pediatric trials
Coadministration with cisplatin may further increase myelosuppression
Documented hypersensitivity to paclitaxel or polyoxyethylated castor oil; peripheral neuropathy; bone marrow suppression; liver failure; severe cardiac disease
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Premedicate with steroids, H1, and H2 blockers to decrease risk of hypersensitivity reactions; myelosuppression, alopecia, arthralgia/myalgias, and cardiac arrhythmia may occur
Antineoplastic Agent, Vesicant
Vinblastine
Vinca alkaloid, inhibits microtubule formation, which disrupts formation of mitotic spindle, causing cell proliferation to arrest at metaphase.
Adult
0.11 mg/kg IV on days 1 and 2; repeat q21d for 4 cycles; adjust dose in hepatic impairment
TB >3 mg/dL: 50% dose reduction
Pediatric
Not established
Phenytoin plasma levels may be reduced when administered concomitantly with vinblastine; with mitomycin, the toxicity of vinblastine may significantly increase; CYP450 3A4 inhibitors (eg, itraconazole, erythromycin,
quinupristin/dalfopristin) may decrease clearance, thus increasing toxicity
Documented hypersensitivity and bone marrow suppression
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in patients diagnosed with impaired liver function and neurotoxicity; when patient is receiving mitomycin C, monitor closely for shortness of breath and bronchospasm
Antineoplastic Agent, Antimetabolite
Gemcitabine
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.
Adult
1000 or 1200 mg/m2 day 1 and 8 every three wks
Pediatric
1.2 g/m2 IV infused over 30 min on days 1, 8, and 15 of 28-d cycles has been used in pediatric trials
None reported
Documented hypersensitivity
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
May cause myelosuppression (particularly thrombocytopenia); toxicities include flu like syndrome, LFT abnormality, maculopapular rash, pruritus, nausea, vomiting, dyspnea, hematuria, proteinuria, and hemolytic uremic syndrome; clearance reduced in women and elderly individuals
Antidote, Cyclosphosphamide-induced Hemorrhagic Cystitis
Mesna
Inactivates acrolein and prevents urothelial toxicity without affecting cytostatic activity.
Adult
1200 mg/m2/d IV continuous infusion on days 1-6 of each cycle; IV dose of mesna equivalent to ifosfamide dose
Pediatric
Not established
May increase warfarin effects
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Does not prevent hemorrhagic cystitis in all patients (monitoring for hematuria in the morning prior to ifosfamide or cyclophosphamide dose required); does not prevent or alleviate other toxicities associated with ifosfamide or cyclophosphamide; common adverse effects include hypotension, headache, GI toxicity, and limb pain
More on Testicular Cancer |
| Overview: Testicular Cancer |
| Differential Diagnoses & Workup: Testicular Cancer |
 Treatment & Medication: Testicular Cancer |
| Follow-up: Testicular Cancer |
| References |
| « Previous Page | Next Page » |
References
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Further Reading
Keywords
testicular cancer symptoms, testicular cancer diagnosis, testicular cancer treatment, germ cell tumors, GCT, seminoma, embryonal carcinoma, teratoma, choriocarcinoma, yolk sac tumor
