Promising novel therapies for relapsed and refractory testicular germ cell tumors

Expert Rev Anticancer Ther. 2021 Jan;21(1):53-69. doi: 10.1080/14737140.2021.1838279. Epub 2020 Nov 2.


Introduction: Germ cell tumors (GCTs) are the most common solid malignancies in young men. The overall cure rate of GCT patients in metastatic stage is excellent, however; patients with relapsed or refractory disease have poor prognosis. Attempts to treat refractory disease with novel effective treatment to improve prognosis have been historically dismal and the ability to predict prognosis and treatment response in GCTs did not sufficiently improve in the last three decades.

Areas covered: We performed a comprehensive literature search of PubMed/MEDLINE to identify original and review articles (years 1964-2020) reporting on current improvement salvage treatment in GCTs and novel treatment options including molecularly targeted therapy and epigenetic approach. Review articles were further searched for additional original articles.

Expert opinion: Despite multimodal treatment approaches the treatment of relapsed or platinum-refractory GCTs remains a challenge. High-dose chemotherapy (HDCT) regimens with autologous stem-cell transplant (ASCT) from peripheral blood showed promising results in larger retrospective studies. Promising results from in vitro studies raised high expectations in molecular targets. So far, the lacking efficacy in small and unselected trials do not shed a light on targeted therapy. Currently, wide inclusion of patients into clinical trials is highly advised.

Keywords: Germ cell tumor; cisplatin resistance; epigenetics; high-dose chemotherapy; refractory germ cell tumor; salvage treatment; targeted therapy.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Humans
  • Male
  • Molecular Targeted Therapy*
  • Neoplasm Recurrence, Local
  • Neoplasms, Germ Cell and Embryonal / pathology
  • Neoplasms, Germ Cell and Embryonal / therapy*
  • Prognosis
  • Salvage Therapy / methods
  • Stem Cell Transplantation / methods
  • Testicular Neoplasms / pathology
  • Testicular Neoplasms / therapy*

Supplementary concepts

  • Testicular Germ Cell Tumor