Management of Refractory Germ Cell Cancer

Over the past 5 decades, the use of well-validated, guideline-based strategies has resulted in high cure rates in newly diagnosed patients with germ cell cancer (GCC). However, about 30% of those with metastatic disease at initial presentation, corresponding to about 5% to 10% of all patients with GCC, will experience refractory disease with progression or recurrence at some time point and need for further therapy. Salvage treatment is far more complex and less validated than first-line treatment because it is rare, patient cohorts are more heterogeneous, and prognostic factors seem to have greater impact. Prior to the initiation of any salvage treatment, several considerations must be made: verification that first-line treatment has failed, search for metastatic sites and extent of disease, assessment of known prognostic factors, and finally choice of the optimal salvage strategy. Careful patient selection will be required to avoid overtreatment and unnecessary long-term toxicity. SPECIAL CONSIDERATIONS Section: ChooseTop of pageAbstractSPECIAL CONSIDERATIONS <