Chemotherapeutic and surgical strategies for germ cell tumors.

Testicular cancer has become a model for a curable neoplasm. Studies of cisplatin combination chemotherapy performed by the author's group allow the following conclusions: (1) short-duration, intensive induction therapy with the most active agents in optimal dosage is more important than maintenance therapy; (2) a modest dose escalation increases toxicity without improving therapeutic efficacy; (3) it is possible to develop curative salvage therapy for refractory germ cell tumors; and (4) preclinical models predicting synergism, such as vinblastine plus bleomycin or cisplatin plus etoposide, have clinical relevance. Testicular cancer has also become a model for new drug development. Cisplatin has been approved by the US Food and Drug Administration for testis and ovarian cancer and VP-16 and ifosfamide for refractory germ cell tumors. The success of these studies confirms the importance of the continued search for new investigational drugs in all solid tumors.