Challenges in the management of relapsed germ cell tumors

Despite the remarkable advances in the treatment of germ cell tumors (GCTs), a significant number of patients relapse after first line treatment. This review aims to highlight the challenges in management of relapsed GCT, discuss treatment options, and review novel therapeutics in development.

Patients with relapsed disease after first line cisplatin-based chemotherapy can still be cured and should be referred to centers with expertise in GCTs. Patients with anatomically confined relapse should be considered for salvage surgery. The systemic treatment of patients with disseminated disease at the time of relapse after first line treatment remains unsettled. Treatment options include using salvage standard-dose cisplatin-based regimens with drugs not previously used or high-dose chemotherapy. Patients who relapse after salvage chemotherapy have poor outcomes and development of novel treatment options is required in this setting.

Management of patients with relapsed GCT requires a multidisciplinary approach. Patients should be preferably evaluated at tertiary care centers with expertise in the management of these patients. There remains a subset of patients who relapse after salvage therapy and development of novel therapeutic approaches is needed in this setting.