[New treatments for germ cell tumors with poor prognosis]

To discuss briefly the new therapeutic strategies for poor-prognosis testicular germ cell cancer.

The use of new drugs in first line chemotherapy, intensive alternating and sequential chemotherapy and high dose chemotherapy with autologous bone marrow or stem cell transplantation are briefly discussed.

Despite the current advancements in the treatment of germ cell tumors, approximately 50% of patients with poor-prognosis germ cell tumors according to the IGCCCG classification die from their disease. In order to improve the results in this group of patients, new therapeutic strategies are currently being investigated, such as the introduction of new drugs to the first line chemotherapeutic regimen. However, randomized studies have shown no benefit from the use of ifosfamide. Phase II trials have shown promising results with intensive alternating and sequential chemotherapy, although the only phase III randomized trial that has been conducted comparing BOP-VIP with BEP showed no advantages. Some phase II trials using high-dose chemotherapy with hematopoietic support in first line treatment of poor-prognosis germ cell tumors have shown promising results. Randomized trials are necessary in this group of patients in order to achieve therapeutic advancements.