Combination Chemotherapy and Pegfilgrastim in Treating Patients With Previously Untreated Germ Cell Tumors

DISEASE CHARACTERISTICS:

• Histologically confirmed germ cell tumor meeting 1 of the following criteria:

  • Poor risk, defined by any of the following:

    • Testis or retroperitoneal primary site nonseminoma histology without visceral metastases but with "poor-risk" markers, defined by any of the following:

      • Pretreatment serum lactate dehydrogenase (LDH) > 10 times upper limit of normal (ULN)
      • Pretreatment serum human chorionic gonadotropin (HCG) > 50,000 IU/L
      • Pretreatment serum alpha fetoprotein (AFP) > 10,000 ng/mL

    • Testis or retroperitoneal primary site nonseminoma histology with one or more nonpulmonary visceral metastases, including any of the following (regardless of serum tumor marker values):

      • Bone metastases
      • Brain metastases
      • Hepatic metastases
      • Any nonpulmonary metastases (i.e., skin, spleen)
    • Mediastinal primary site nonseminoma histology regardless of serum tumor marker levels or presence/absence of visceral metastases

  • Modified intermediate risk, defined by any of the following:

    • Testis or retroperitoneal primary site nonseminoma histology with no nonpulmonary visceral metastases, and with any of the following serum marker values:

      • Pretreatment serum LDH 3.0-10 times ULN
      • Pretreatment serum HCG 5,000-50,000 IU/L
      • Pretreatment serum AFP 1,000-10,000 ng/mL

    • Seminoma histology with one or more nonpulmonary visceral metastases, including any of the following (regardless of serum tumor marker values or primary site):

      • Bone metastases
      • Brain metastases
      • Hepatic metastases
      • Any nonpulmonary visceral metastases (i.e., skin, spleen)
• Previously untreated disease
• Measurable or evaluable disease

PATIENT CHARACTERISTICS:

• WBC ≥ 3,000/mm^3
• Platelet count ≥ 100,000/mm^3
• Creatinine normal or creatinine clearance > 50 mL/min (unless renal dysfunction is due to tumor obstructing the ureters)
• AST and ALT ≤ 3 times ULN
• Bilirubin ≤ 2.0 times ULN
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• No concurrent malignancy except for nonmelanoma skin cancer
• No known HIV positivity
• No active infections

PRIOR CONCURRENT THERAPY:

• Recovered from prior surgery
• More than 30 days since prior radiotherapy and recovered (unless evidence of progressive disease has been documented)
• No prior chemotherapy
• No other concurrent cytotoxic therapy
• Concurrent radiotherapy and surgery allowed for treatment of brain metastases