Role of High-Dose Chemotherapy With Autologous Stem-Cell Rescue in Men With Previously Treated Germ Cell Tumors

J Clin Oncol. 2017 Apr 1;35(10):1036-1040. doi: 10.1200/JCO.2016.70.6523. Epub 2016 Dec 19.


The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 39-year-old, previously healthy man presented with a left testicular mass, confirmed on ultrasound. He underwent left inguinal orchiectomy, which disclosed testicular carcinoma composed of 90% choriocarcinoma, 9% seminoma, and 1% teratoma. Imaging revealed numerous metastases in the lungs, liver, and brain. Prechemotherapy levels of serum tumor markers were alpha-fetoprotein (AFP) 2.0 ng/mL, human chorionic gonadotropin (hCG) 151,111 IU/L, and lactate dehydrogenase 588 U/L. He received four courses of etoposide, ifosfamide, and cisplatin chemotherapy, given without bleomycin because of the anticipated need for postchemotherapy thoracic surgery. He had an incomplete response to induction chemotherapy. The serum hCG level was 8.1 IU/L, and there were residual lesions in the liver and lungs whereas the brain metastases had nearly resolved. His Eastern Cooperative Oncology Group performance status was zero. He had no symptoms of ototoxicity or peripheral neurotoxicity. Repeat serum hCG levels after chemotherapy were 12.3 IU/L at 2 weeks and 325 IU/L at 4 weeks. He was referred to discuss optimal ongoing treatment.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Brain Neoplasms / secondary
  • Brain Neoplasms / therapy*
  • Cisplatin / administration & dosage
  • Combined Modality Therapy
  • Etoposide / administration & dosage
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Ifosfamide / administration & dosage
  • Liver Neoplasms / secondary
  • Liver Neoplasms / therapy*
  • Lung Neoplasms / secondary
  • Lung Neoplasms / therapy*
  • Male
  • Neoplasms, Complex and Mixed / secondary
  • Neoplasms, Complex and Mixed / therapy*
  • Neoplasms, Germ Cell and Embryonal / secondary
  • Neoplasms, Germ Cell and Embryonal / therapy*
  • Orchiectomy
  • Testicular Neoplasms / pathology
  • Testicular Neoplasms / therapy*
  • Transplantation, Autologous


  • Etoposide
  • Cisplatin
  • Ifosfamide