While significant progress has been made in the last three decades in the treatment of patients with germ cell tumors and while most patients can now reasonably expect to be cured, chemotherapy regimens for this disease continue to have significant side effects. However, progress has been made in ameliorating the toxicity profiles, and significantly fewer patients now experience such morbidities as renal failure, hemorrhagic cystitis, and bleomycin-induced pneu-monitis. Newer chemotherapeutic agents such as paclitaxel and gemicitabine have distinct patterns of side effects and must be assessed carefully to establish how their toxicity interacts with the conventional cytotoxic agents that are used in patients with this disease. As new approaches for reducing side effects are evaluated, the efficacy of current management must be maintained and not sacrificed in pursuit of a more attractive toxicity profile.
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