Extragonadal germ cell tumour: the decisions you may face

Cancer page →Second-opinion finder →

3 treatment settings, 3 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.

Other settings

Seminoma (mediastinal or retroperitoneal)

3 optionsCompare side by side →

BEP for three cycles or EP for four; radiotherapy only for small retroperitoneal disease; PET to assess residual masses.

The options, in plain words

BleomycinApprovedGlycopeptide antibiotic (DNA-cleaving)

Bleomycin is the 'B' in BEP for testicular cancer and ABVD for Hodgkin lymphoma; its unique danger is scarring of the lungs, so lung function is monitored and it is often dropped when safe.

EtoposideApprovedTopoisomerase II inhibitor (podophyllotoxin derivative)

Etoposide is a chemotherapy from the mayapple plant, essential to curing testicular cancer (BEP), treating small-cell lung cancer, lymphomas, childhood sarcomas and leukaemias, and used in transplant conditioning.

CisplatinApprovedCytotoxic chemotherapy (platinum)

Cisplatin is the original platinum chemotherapy, discovered by accident in 1965; it cures testicular cancer and makes radiation work better in cervical and head and neck cancer.

The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record

Bleomycin all recorded rates →

Pulmonary toxicity rises with G-CSF, high inspired oxygen, renal impairment and age over 40.
Reduce for CrCl below 50.

Etoposide all recorded rates →

Reduce to 75% for CrCl 15-50.

Cisplatin all recorded rates →

Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).

Questions to ask about this decision

Between Bleomycin, Etoposide and Cisplatin, which do you recommend for me, and what about my case would make you choose differently?
Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
Why: The aim shapes how much side effect and disruption is worth accepting.
What happens if I delay, or decline this step for now? Is the decision reversible?
Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
For my situation (seminoma (mediastinal or retroperitoneal)), which of the standard options do you recommend and why?
Why: Guideline options include: BEP for three cycles or EP for four; radiotherapy only for small retroperitoneal disease; PET to assess residual masses.
Am I a candidate for Bleomycin, Etoposide, Cisplatin, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.

Other settings

Non-seminoma, retroperitoneal

3 optionsCompare side by side →

BEP for three or four cycles by IGCCCG risk group, then resection of residual masses over one centimetre.

The options, in plain words

BleomycinApprovedGlycopeptide antibiotic (DNA-cleaving)

Bleomycin is the 'B' in BEP for testicular cancer and ABVD for Hodgkin lymphoma; its unique danger is scarring of the lungs, so lung function is monitored and it is often dropped when safe.

EtoposideApprovedTopoisomerase II inhibitor (podophyllotoxin derivative)

CisplatinApprovedCytotoxic chemotherapy (platinum)

Cisplatin is the original platinum chemotherapy, discovered by accident in 1965; it cures testicular cancer and makes radiation work better in cervical and head and neck cancer.

The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record

Bleomycin all recorded rates →

Pulmonary toxicity rises with G-CSF, high inspired oxygen, renal impairment and age over 40.
Reduce for CrCl below 50.

Etoposide all recorded rates →

Reduce to 75% for CrCl 15-50.

Cisplatin all recorded rates →

Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).

Questions to ask about this decision

Between Bleomycin, Etoposide and Cisplatin, which do you recommend for me, and what about my case would make you choose differently?
Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
Why: The aim shapes how much side effect and disruption is worth accepting.
What happens if I delay, or decline this step for now? Is the decision reversible?
Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
For my situation (non-seminoma, retroperitoneal), which of the standard options do you recommend and why?
Why: Guideline options include: BEP for three or four cycles by IGCCCG risk group, then resection of residual masses over one centimetre.
Am I a candidate for Bleomycin, Etoposide, Cisplatin, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.

Other settings

Non-seminoma, mediastinal (poor risk)

3 optionsCompare side by side →

Four cycles of BEP or VIP, then surgery of residual disease; consider high-dose chemotherapy with autologous stem cell rescue at relapse; treat in a specialist centre.

The options, in plain words

EtoposideApprovedTopoisomerase II inhibitor (podophyllotoxin derivative)

IfosfamideApprovedCytotoxic chemotherapy (alkylating agent)

Ifosfamide is an alkylating chemotherapy partnered with doxorubicin in sarcoma and with etoposide in Ewing sarcoma, given with a bladder-protecting drug.

CisplatinApprovedCytotoxic chemotherapy (platinum)

Cisplatin is the original platinum chemotherapy, discovered by accident in 1965; it cures testicular cancer and makes radiation work better in cervical and head and neck cancer.

The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record

Etoposide all recorded rates →

Reduce to 75% for CrCl 15-50.

Cisplatin all recorded rates →

Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).

Questions to ask about this decision

Between Etoposide, Ifosfamide and Cisplatin, which do you recommend for me, and what about my case would make you choose differently?
Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
Why: The aim shapes how much side effect and disruption is worth accepting.
What happens if I delay, or decline this step for now? Is the decision reversible?
Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
For my situation (non-seminoma, mediastinal (poor risk)), which of the standard options do you recommend and why?
Why: Guideline options include: Four cycles of BEP or VIP, then surgery of residual disease; consider high-dose chemotherapy with autologous stem cell rescue at relapse; treat in a specialist centre.
Am I a candidate for Etoposide, Ifosfamide, Cisplatin, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.

How to read this page. Options and results come from OnCo records with their sources; the settings are the standard-of-care rows on the cancer page, and the lines of therapy are on the sequencing grid. Where a setting names one path, the choice is usually about timing, trials and where to be treated: see expert centres. OnCo is orientation, not medical advice.

Living with cancer·Standard of care

Extragonadal germ cell tumour: the decisions you may face

Cancer page →Second-opinion finder →

Other settings

Seminoma (mediastinal or retroperitoneal)

3 optionsCompare side by side →

BEP for three cycles or EP for four; radiotherapy only for small retroperitoneal disease; PET to assess residual masses.

The options, in plain words

BleomycinApprovedGlycopeptide antibiotic (DNA-cleaving)

Bleomycin is the 'B' in BEP for testicular cancer and ABVD for Hodgkin lymphoma; its unique danger is scarring of the lungs, so lung function is monitored and it is often dropped when safe.

EtoposideApprovedTopoisomerase II inhibitor (podophyllotoxin derivative)

CisplatinApprovedCytotoxic chemotherapy (platinum)

Cisplatin is the original platinum chemotherapy, discovered by accident in 1965; it cures testicular cancer and makes radiation work better in cervical and head and neck cancer.

The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record

Bleomycin all recorded rates →

Pulmonary toxicity rises with G-CSF, high inspired oxygen, renal impairment and age over 40.
Reduce for CrCl below 50.

Etoposide all recorded rates →

Reduce to 75% for CrCl 15-50.

Cisplatin all recorded rates →

Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).

Questions to ask about this decision

Between Bleomycin, Etoposide and Cisplatin, which do you recommend for me, and what about my case would make you choose differently?
Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
Why: The aim shapes how much side effect and disruption is worth accepting.
What happens if I delay, or decline this step for now? Is the decision reversible?
Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
For my situation (seminoma (mediastinal or retroperitoneal)), which of the standard options do you recommend and why?
Why: Guideline options include: BEP for three cycles or EP for four; radiotherapy only for small retroperitoneal disease; PET to assess residual masses.
Am I a candidate for Bleomycin, Etoposide, Cisplatin, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.

Other settings

Non-seminoma, retroperitoneal

3 optionsCompare side by side →

BEP for three or four cycles by IGCCCG risk group, then resection of residual masses over one centimetre.

The options, in plain words

BleomycinApprovedGlycopeptide antibiotic (DNA-cleaving)

Bleomycin is the 'B' in BEP for testicular cancer and ABVD for Hodgkin lymphoma; its unique danger is scarring of the lungs, so lung function is monitored and it is often dropped when safe.

EtoposideApprovedTopoisomerase II inhibitor (podophyllotoxin derivative)

CisplatinApprovedCytotoxic chemotherapy (platinum)

Cisplatin is the original platinum chemotherapy, discovered by accident in 1965; it cures testicular cancer and makes radiation work better in cervical and head and neck cancer.

The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record

Bleomycin all recorded rates →

Pulmonary toxicity rises with G-CSF, high inspired oxygen, renal impairment and age over 40.
Reduce for CrCl below 50.

Etoposide all recorded rates →

Reduce to 75% for CrCl 15-50.

Cisplatin all recorded rates →

Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).

Questions to ask about this decision

Between Bleomycin, Etoposide and Cisplatin, which do you recommend for me, and what about my case would make you choose differently?
Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
Why: The aim shapes how much side effect and disruption is worth accepting.
What happens if I delay, or decline this step for now? Is the decision reversible?
Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
For my situation (non-seminoma, retroperitoneal), which of the standard options do you recommend and why?
Why: Guideline options include: BEP for three or four cycles by IGCCCG risk group, then resection of residual masses over one centimetre.
Am I a candidate for Bleomycin, Etoposide, Cisplatin, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.

Other settings

Non-seminoma, mediastinal (poor risk)

3 optionsCompare side by side →

Four cycles of BEP or VIP, then surgery of residual disease; consider high-dose chemotherapy with autologous stem cell rescue at relapse; treat in a specialist centre.

The options, in plain words

EtoposideApprovedTopoisomerase II inhibitor (podophyllotoxin derivative)

IfosfamideApprovedCytotoxic chemotherapy (alkylating agent)

Ifosfamide is an alkylating chemotherapy partnered with doxorubicin in sarcoma and with etoposide in Ewing sarcoma, given with a bladder-protecting drug.

CisplatinApprovedCytotoxic chemotherapy (platinum)

Cisplatin is the original platinum chemotherapy, discovered by accident in 1965; it cures testicular cancer and makes radiation work better in cervical and head and neck cancer.

The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record

Etoposide all recorded rates →

Reduce to 75% for CrCl 15-50.

Cisplatin all recorded rates →

Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).

Questions to ask about this decision

Between Etoposide, Ifosfamide and Cisplatin, which do you recommend for me, and what about my case would make you choose differently?
Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
Why: The aim shapes how much side effect and disruption is worth accepting.
What happens if I delay, or decline this step for now? Is the decision reversible?
Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
For my situation (non-seminoma, mediastinal (poor risk)), which of the standard options do you recommend and why?
Why: Guideline options include: Four cycles of BEP or VIP, then surgery of residual disease; consider high-dose chemotherapy with autologous stem cell rescue at relapse; treat in a specialist centre.
Am I a candidate for Etoposide, Ifosfamide, Cisplatin, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.