The choice of a regimen remains one of the major unresolved issues in the treatment of poor-risk germ cell cancer with high-dose chemotherapy and stem cell support. Elements of regimen design include (1) the safety of each agent at the dose and schedule and in the combination selected for study, (2) the timing of this modality and the use of alternative regimens such as multicycle highdose therapy, (3) tandem cycles using different agents in each cycle, and (4) the incorporation of new pharmacologic agents. Each of these aspects of high-dose chemotherapy for germ cell tumors are discussed.
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