Testicular Cancer

Question 1

PRIMARY CHEMOTHERAPY REGIMENS FOR GERM CELL TUMORS

Answer 1

EP
Etoposide 100 mg/m2 IV on Days 1–5 Cisplatin 20 mg/m2 IV on Days 1–5
Repeat every 21 days

BEP 
Etoposide 100 mg/m2 IV on Days 1–5 
Cisplatin 20 mg/m2 IV on Days 1–5 
Bleomycin 30 units IV weekly on Days 1, 8, and 15 or Days 2, 9, and 16 
Repeat every 21 days

VIP
Etoposide 75 mg/m2 IV on Days 1–5
Mesna 120 mg/m2 slow IV Push before ifosfamide on Day 1, then
Mesna 1200 mg/m2 IV Continuous Infusion on Days 1–5
Ifosfamide 1200 mg/m2 on Days 1–5
Cisplatin 20 mg/m2 IV on Days 1–5
Repeat every 21 days

Question 2

SECOND-LINE CHEMOTHERAPY REGIMENS FOR METASTATIC GERM CELL TUMORS

Answer 2

VeIP
Vinblastine 0.11 mg/kg IV Push on Days 1–2 Mesna 400 mg/m2 IV every 8 hours on Days 1–5 Ifosfamide 1200 mg/m2 IV on Days 1–5
Cisplatin 20 mg/m2 IV on Days 1–5
Repeat every 21 days1

TIP 
Paclitaxel 250 mg/m2 IV on Day 1 
Ifosfamide 1500 mg/m2 IV on Days 2–5 
Mesna 500 mg/m2 IV before ifosfamide, and then 4 and 8 hours after each ifosfamide dose on Days 2–5 
Cisplatin 25 mg/m2 IV on Days 2–5 
Repeat every 21 days

Carboplatin 700 mg/m2 (body surface area) IV Etoposide 750 mg/m2 IV Administer 5, 4, and 3 days before peripheral blood stem cell infusion for 2 cycles

Paclitaxel 200 mg/m2 IV over 24 hours on Day 1 Ifosfamide 2000 mg/m2 over 4 hours with mesna protection on Days 2–4
Repeat every 14 days for 2 cycles followed by Carboplatin AUC 7–8 IV over 60 minutes Days 1–3 Etoposide 400 mg/m2 IV Days 1–3 Administer with peripheral blood stem cell support at 14- to 21-day intervals for 3 cycles

Question 3

SUBSEQUENT CHEMOTHERAPY REGIMENS FOR METASTATIC GERM CELL TUMORS

Answer 3

Gemcitabine/oxaliplatin
Gemcitabine/paclitaxel
Gemcitabine/paclitaxel/oxaliplatin
Etoposide (oral)