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Current Management of Refractory Germ Cell Tumors
Omar Abughanimeh1, Benjamin A Teply2
1Division of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE, 68198-6840, USA.
Purpose Of Review:
Germ cell tumors (GCTs) are the most common solid tumors affecting men between ages of 20 and 34 years. Most of the cases, even in advanced disease, will have good prognosis. However, around 20-30% of advanced disease will be refractory or develop relapse after treatment. Herein, we review the current management of refractory/relapsed GCTs.
Recent Findings:
Salvage treatment of GCTs has been a controversial topic for the last few decades. Conventional dose chemotherapy (CDCT), high-dose chemotherapy (HDCT) with stem cell infusion, and surgical salvage were proven to be effective and curative options in some cases. The international randomized trial (TIGER) will ultimately answer which chemotherapy approach may be optimal. Furthermore, the usage of immunotherapy is still under investigation with limited data so far in the setting of relapsed/refractory GCTs. Curative paradigms including with CDCT and HDCT are possible, although novel approaches beyond HDCT are still needed to eliminate mortality from this disease.
Insights
Germ cell tumors (GCTs) in advanced stages can be refractory or relapse. Current salvage treatments include conventional dose chemotherapy, high-dose chemotherapy with stem cell infusion, and surgery, though novel approaches are needed.
Area of Science:
- Oncology
- Urology
Background:
- Germ cell tumors (GCTs) are the most common solid tumors in men aged 20-34.
- While prognosis is generally good, 20-30% of advanced GCTs become refractory or relapse post-treatment.
Purpose of the Study:
- To review the current management strategies for refractory or relapsed GCTs.
- To discuss established and emerging treatment options for GCTs that do not respond to initial therapy or recur.
Main Methods:
- Review of current literature on salvage treatments for GCTs.
- Discussion of conventional dose chemotherapy (CDCT), high-dose chemotherapy (HDCT) with stem cell infusion, and surgical salvage.
- Consideration of ongoing trials like TIGER and the role of immunotherapy.
Main Results:
- CDCT, HDCT, and surgical salvage are established curative options for some patients.
- The optimal chemotherapy approach is still under investigation (e.g., TIGER trial).
- Immunotherapy for relapsed/refractory GCTs has limited supporting data currently.
Conclusions:
- Curative treatment paradigms exist for relapsed/refractory GCTs using CDCT and HDCT.
- Novel therapeutic approaches beyond HDCT are essential to further reduce mortality in these challenging cases.
