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Therapy-associated secondary tumors in patients with non-germinomatous malignant germ cell tumors
Hideo Nakamura1, Keishi Makino, Yukitaka Ushio
1Department of Neurosurgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan. hnakamur@fc.kuh.kumamoto-u.ac.jp
Abstract:
We report three patients with non-germinomatous malignant germ cell tumor (NGMGCT) who developed therapy-associated secondary tumors. They were diagnosed as having NGMGCT by elevated serum levels of α-fetoprotein (AFP), human chorionic gonadotropin (HCG), or β-HCG. Preoperatively, all patients received a combination of etoposide and platinum-based chemotherapy and radiotherapy; neo-adjuvant therapy (NAT) was followed by complete excision of the residual tumor. Postoperatively, all underwent maintenance chemotherapy and all remained free of NGMGCT without recurrence. However, they developed therapy-associated secondary tumors, i.e. glioblastoma, meningioma, or cavernous angioma after 10.1, 9.8, and 8.2 years, respectively. The patient with glioblastoma died one year after its detection. The other two patients are currently alive; the meningioma was completely removed and the cavernous angioma is being monitored without additional treatment. To the best of our knowledge, therapy-associated secondary tumors in patients treated for NGMGCT are rare.
Insights
Three patients treated for malignant germ cell tumors developed secondary tumors like glioblastoma and meningioma years later. This highlights a rare but serious long-term risk associated with cancer therapy.
Area of Science:
- Oncology
- Neuro-oncology
- Pediatric Oncology
Background:
- Malignant germ cell tumors (GCTs) are rare cancers.
- Non-germinomatous malignant germ cell tumor (NGMGCT) diagnosis relies on specific tumor markers.
- Treatment often involves aggressive multimodal therapy including chemotherapy and radiotherapy.
Observation:
- Three patients with NGMGCT developed secondary tumors after treatment.
- Secondary tumors observed include glioblastoma, meningioma, and cavernous angioma.
- These occurred 8.2 to 10.1 years post-treatment.
Findings:
- All patients achieved complete remission from their primary NGMGCT.
- Secondary tumors arose as a consequence of prior cancer therapies.
- Survival varied, with one fatality and two patients alive with managed secondary tumors.
Implications:
- Long-term surveillance for secondary malignancies is crucial in NGMGCT survivors.
- Understanding the risks of therapy-associated tumors is vital for optimizing treatment protocols.
- Further research into the mechanisms of secondary tumorigenesis in GCT patients is warranted.
