Standard therapy for patients with poor-risk germ cell tumors remains four cycles of bleomycin, etoposide, and cisplatin (BEP) chemotherapy, which cures approximately 50% of this patient population. Randomized trials of conventional-dose chemotherapy have failed to identify a regimen with superior efficacy to BEP. Preliminary data suggesting efficacy for high-dose chemotherapy with stem cell or autologous bone marrow transplantation as initial therapy for poor-risk disease have led to two randomized trials of this approach as initial therapy for poor-risk patients. The recently developed International Germ Cell Consensus Classification provides a standard method for determining poor-risk status and should be uniformly applied for both clinical decision making and risk assignment in clinical trials.
