A large Nordic study has provided new evidence on the role of high-dose chemotherapy (HDCT) with autologous stem-cell support in men with germ cell cancer, a rare but usually highly curable form of testicular cancer. The research, led by the Swedish and Norwegian Testicular Cancer Group (SWENOTECA), addresses ongoing international uncertainty about which patients should receive HDCT and at what stage of treatment.
Between 2011 and 2021, 7,322 men were diagnosed with germ cell cancer in Sweden and Norway. Only 80 patients – around 1.1% of the total – were treated with HDCT, underlining its use as a highly selected and intensive option. Patients received HDCT for one of three reasons: delayed decline in tumour markers during primary or intensified primary chemotherapy, progressive disease, or relapse following earlier treatment. All patients were treated according to harmonised SWENOTECA guidelines, using two cycles of carboplatin and etoposide supported by autologous stem-cell transplantation.
Across all indications, outcomes were encouraging. Five-year overall survival after HDCT was 55%, while five-year progression-free survival was 43%. However, survival varied substantially depending on the clinical situation in which HDCT was introduced.
Early intensification shows strongest benefit
Patients treated early because of delayed tumour-marker decline during primary chemotherapy experienced the most favourable outcomes. In this group, five-year overall survival reached 75%, with progression-free survival of 53%. Notably, no treatment-related deaths were reported in these patients, suggesting that early intensification to HDCT can be delivered safely when carefully selected and closely monitored.
Results were less favourable among patients treated for progressive disease, where five-year overall survival was 29% and progression-free survival just 18%. Patients who received HDCT after relapse achieved intermediate outcomes, with five-year overall survival of 61% and progression-free survival of 58%.
Toxicity remained a significant concern. Four patients, equivalent to 5% of those treated, died as a result of HDCT-related complications. Severe grade 3–4 infections were common, affecting 86% of patients.
Clinical implications
Despite these risks, the authors conclude that HDCT delivered within the SWENOTECA programme is feasible and associated with promising survival, particularly when used early in patients with inadequate response to standard chemotherapy. The findings support a more proactive and standardised approach to HDCT in carefully selected men with germ cell cancer.
Reference
Jansson AK et al. High-dose chemotherapy in male germ cell cancer patients—a study by the SWENOTECA group. British Journal of Cancer. 2025; https://doi.org/10.1038/s41416-025-03322-9.
