Accelerated BEP Chemotherapy for Intermediate and High Risk Metastatic Germ Cell Tumor

Inclusion Criteria

DISEASE CHARACTERISTICS:

- Patients must fulfill all of the following criteria for 1 of the following diagnoses:

- Nonseminoma germ cell tumor (intermediate risk)

- Testis or retroperitoneal primary

- Abnormal markers (alpha fetoprotein [AFP] > 1,000 and < 10,000 ng/mL, human
chorionic gonadotropin [HCG] > 5,000 and < 50,000 IU/L, lactate
dehydrogenase [LDH] > 1.5 times and < 10 times upper limit of normal [ULN])

- No liver, bone, brain, or other nonpulmonary visceral metastasis

- Histologic confirmation is not required if AFP or HCG are grossly elevated

- Nonseminoma germ cell tumor (poor prognosis) meeting 1 of the following
criteria:

- Mediastinal primary

- Nonpulmonary visceral metastases

- Poor markers (AFP > 10,000 ng/mL, HCG > 50,000 IU/L, LDH > 10 times ULN)

- Histologic confirmation not required if AFP or HCG are grossly elevated

- Seminoma (intermediate prognosis)

- Histological confirmation is required

- Any primary site

- Nonpulmonary visceral metastases must be present

- Normal AFP

- Any HCG

- Any LDH

- Surveillance relapse

- Must fulfill appropriate criteria above according to initial histology

PATIENT CHARACTERISTICS:

- Neutrophil count ≥ 1,000/mm³

- Platelet count ≥ 100,000/mm³

- Must have adequate renal function (creatinine clearance ≥ 60 mL/min)

- No prior malignancy except basal cell carcinoma

PRIOR CONCURRENT THERAPY:

- No prior chemotherapy or radiotherapy