Is there still indication of high-dose chemotherapy with hematopoietic stem-cell support in the treatment of germ-cell tumors?

Germ-cell tumor patients are cured in 80% of cases. Twenty per cent of patients had a relapse or an incomplete response after first line chemotherapy, and only one third of them are alive free of disease at long term. Different approaches were performed to increase the results either in first line chemotherapy of poor prognosis patients or in first salvage. High dose chemotherapy with stem-cell support is one of them. The drugs infused are etoposide, carboplatin, cyclophosphamide and ifosfamide. Actually, no randomized performed trial showed the superiority of high dose chemotherapy in first line or in salvage treatment. Randomized trials are on going in these two settings. High dose chemotherapy is not actually a standard treatment in germ cell tumors.