Extragonadal Germ Cell Tumors Medication

Updated: Aug 24, 2021
  • Author: Kush Sachdeva, MD; Chief Editor: E Jason Abel, MD  more...
  • Print

Medication Summary

The goals of pharmacotherapy are to induce remission, reduce morbidity, and prevent complications. Platinum-based combination chemotherapy regimens are standard.


Chemotherapeutic agents

Class Summary

Regardless of the tumor location and whenever chemotherapy is considered, a BEP combination (bleomycin, etoposide, and cisplatin) is the treatment of choice (BEP for 4 cycles at 3-wk intervals). VIP (etoposide, ifosfamide, and cisplatin) has been used as salvage therapy for progressive disease or as postoperative therapy following resection of residual mass containing viable tumor. Vinblastine has occasionally replaced etoposide if the latter was used in the initial regimen.

Cisplatin (Platinol)

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 produce cross-links. Platinum complex also can bind to nucleus and cytoplasmic protein. A bifunctional alkylating agent, once activated to aquated form in cell it binds to DNA, resulting in interstrand and intrastrand cross-linking.

Modify dose on basis of creatinine clearance (CrCl). Avoid use if CrCl < 60 mL/min.

Etoposide (Toposar, VePesid)

Inhibits topoisomerase II and causes DNA strand breakage, causing cell proliferation to arrest in late S or early G2 portion of cell cycle. Prodrug activated by dephosphorylation.

Reduce dose in hepatic (increased total bilirubin [TB]) and renal (decreased CrCl) impairment.

Bleomycin (Blenoxane)

Glycopeptide antibiotic that acts by intercalating and binding to guanosine and cytosine portions of DNA. May induce single- or double-stranded DNA breaks by ability to form oxygen free radicals.

Test dose is optional: 1-2 U IV/IM prior to full dose.

Ifosfamide (Ifex)

Alkylating agent—2 major metabolites are produced after its activation in liver. Ifosfamide mustard, by its ability to cross-link DNA strands, responsible for therapeutic effect. Acrolein related to bladder toxicity.

Vinblastine (Velban)

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

Reduce dose by 50% in patients with TB > 3 mg/dL. Dose reduction not required in impaired renal function.