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Medication

Medication Summary

Metastatic pure choriocarcinoma is treated with the same multi-agent chemotherapy regimens used in nonseminomatous germ cell tumors (NSGCTs), which are discussed in a separate article (see Nonseminomatous Testicular Tumors).

Standard chemotherapy for poor-risk patients and some good-to-moderate–risk patients includes 4 cycles of BEP (ie, bleomycin, etoposide, cisplatin). Additional agents in some regimens or for salvage include vinblastine and ifosfamide.

Most case reports show a poor response to chemotherapy, and the literature offers no clear treatment guidelines.^{[7, 18, 31, 10, 32]}

Class Summary

These agents inhibit cell growth and proliferation.

Bleomycin (Blenoxane)

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Composed of cytotoxic glycopeptide antibiotics, which appear to inhibit DNA synthesis, with some evidence of RNA and protein synthesis inhibition to a lesser degree. Used in the management of several neoplasms as a palliative measure; however, it is an important part of curative regimens for testicular cancer.

Etoposide (Toposar, VePesid)

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Arrests cells in the G₂ portion of the cell cycle and induces DNA strand breaks by interacting with DNA topoisomerase II and forming free radicals.

Cisplatin (Platinol, Platinol-AQ)

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Inorganic metal complex thought to act analogously to alkylating agents. Kills cells in all stages of cell cycle and inhibits DNA biosynthesis.

Ifosfamide (Ifex)

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Related to nitrogen mustards and a synthetic analog of cyclophosphamide.

Vinblastine (Alkaban-AQ, Velban)

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Alkaloid derivative that causes depolymerization of microtubules important to the mitotic spindle and cytoskeleton.

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Media Gallery

Testicular choriocarcinoma has multinucleated syncytiotrophoblastic cells that drape over smaller cytotrophoblastic cells, which together appear to form a border along a blood-filled villouslike space (upper right). Used with permission from Ernstoff MS, Heaney JA, and Peschel RE, eds. Testicular and Penile Cancer. Malden, Mass: Blackwell Science, Inc; 1998:20.

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Table 1. Serum Tumor Markers (S)

S	LDH		HCG (mIU/mL)		AFP (ng/mL)
Sx	Not assessed		Not assessed		Not assessed
S0	Normal	and	Normal	and	Normal
S1	< 1.5 x N	and	< 5000	and	< 1000
S2	1.5-10 x N	or	5000-50,000	or	1000-10,000
S3	>10 x N	or	>50,000	or	>10,000
*N=upper limit of reference range for the LDH assay

Table 2. Stage Grouping

Stage grouping	T	N	M	S
Stage 0	pTis	N0	M0	S0
Stage I	pT1-T4	N0	M0	Sx
Stage IA	pT1	N0	M0	S0
Stage IB	pT2-4	N0	M0	S0
Stage IS	Any pT/TX	N0	M0	S1-S3
Stage II	Any pT/TX	N1-3	M0	Sx
Stage IIA	Any pT/TX	N1	M0	S0-S1
Stage IIB	Any pT/TX	N2	M0	S0-S1
Stage IIC	Any pT/TX	N3	M0	S0-S1
Stage III	Any pT/TX	Any N	M1	Sx
Stage IIIA	Any pT/TX	Any N	M1a	S0-S1
Stage IIIB	Any pT/TX	N1-3	M0	S2
…	Any pT/TX	Any N	M1a	S2
Stage IIIC	Any pT/TX	N1-3	M0	S3
…	Any pT/TX	Any N	M1a	S3
…	Any pT/TX	Any N	M1b	Any S

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Author

Michael B Williams, MD, MS Assistant Professor, Department of Urology, Leroy T Canoles, Jr, Cancer Research Center, Eastern Virginia Medical School

Michael B Williams, MD, MS is a member of the following medical societies: American Association for Cancer Research, American Urological Association, Society of Urologic Oncology, Texas Medical Association, American Society of Clinical Oncology, American Association of Clinical Urologists

Disclosure: Nothing to disclose.

Coauthor(s)

Paul F Schellhammer, MD Professor of Urology, Eastern Virginia Medical School; Urologist, Urology of Virginia, PC

Paul F Schellhammer, MD is a member of the following medical societies: American Medical Association, American Urological Association, Society of Surgical Oncology, Society of Urologic 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

Bradley Fields Schwartz, DO, FACS Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, Society of University Urologists

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Endourological Society Board of Directors; President Elect North Central Section of the American Urological Association<br/>Serve(d) as a speaker or a member of a speakers bureau for: Cook Medical.

Additional Contributors

Leonard Gabriel Gomella, MD, FACS The Bernard W Godwin Professor of Prostate Cancer Chairman, Department of Urology, Associate Director of Clinical Affairs, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Leonard Gabriel Gomella, MD, FACS is a member of the following medical societies: American Association for Cancer Research, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Urological Association, Sigma Xi, The Scientific Research Honor Society, Society for Basic Urologic Research, Society of University Urologists, Society of Urologic Oncology

Disclosure: Received consulting fee from GSK for consulting; Received honoraria from Astra Zeneca for speaking and teaching; Received consulting fee from Watson Pharmaceuticals for consulting.

Acknowledgements

John W Davis, MD Assistant Professor, Department of Urology, University of Texas MD Anderson Cancer Center

John W Davis, MD is a member of the following medical societies: American College of Surgeons and American Urological Association

Disclosure: Nothing to disclose.

Dan Theodorescu, MD, PhD Paul A Bunn Professor of Cancer Research, Professor of Surgery and Pharmacology, Director, University of Colorado Comprehensive Cancer Center

Dan Theodorescu, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Urological Association, Medical Society of Virginia, Society for Basic Urologic Research, and Society of Urologic Oncology

Disclosure: Key Genomics Ownership interest Co-Founder-50% Stock Ownership; KromaTiD, Inc Stock Options Board membership

Testicular Choriocarcinoma Medication

Medication Summary

Antineoplastic agents

Class Summary

Bleomycin (Blenoxane)

Bleomycin (Blenoxane)

Etoposide (Toposar, VePesid)

Etoposide (Toposar, VePesid)

Cisplatin (Platinol, Platinol-AQ)

Cisplatin (Platinol, Platinol-AQ)

Ifosfamide (Ifex)

Ifosfamide (Ifex)

Vinblastine (Alkaban-AQ, Velban)

Vinblastine (Alkaban-AQ, Velban)

Testicular Choriocarcinoma Medication

Medication Summary

Antineoplastic agents

Class Summary

Bleomycin (Blenoxane)

Bleomycin (Blenoxane)

Etoposide (Toposar, VePesid)

Etoposide (Toposar, VePesid)

Cisplatin (Platinol, Platinol-AQ)

Cisplatin (Platinol, Platinol-AQ)

Ifosfamide (Ifex)

Ifosfamide (Ifex)

Vinblastine (Alkaban-AQ, Velban)

Vinblastine (Alkaban-AQ, Velban)

References

Tables

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