Recent developments in the management of germ cell tumors

• Type of Material: Article
• Authors: Pavlos Msaouel, The University of Texas M.D. Anderson Cancer Center; Mehmet Asim Bilen, Emory University; Miao Zhang, The University of Texas M.D. Anderson Cancer Center; Matthew Campbell, The University of Texas M.D. Anderson Cancer Center; Jennfier Wang, The University of Texas M.D. Anderson Cancer Center; Shi-Ming Tu, The University of Texas M.D. Anderson Cancer Center
• Language: English
• Date: 2017-05-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1097/CCO.0000000000000361
• Title of Journal or Parent Work: Current Opinion in Oncology
• ISSN: 1040-8746
• Volume: 29
• Issue: 3
• Start Page: 172
• End Page: 178
• Grant/Funding Information: Pavlos Msaouel is supported by the National Institutes of Health T32 CA009666 grant.; This work was supported in part by the National Institutes of Health through MD Anderson’s Cancer Center Support Grant CA016672 (used the Clinical Trials Support Resource)
• Keywords: LONG-TERM SURVIVORS; Oncology; Science & Technology; Life Sciences & Biomedicine; LYMPH-NODE DISSECTION; testicular cancer; DOSE CHEMOTHERAPY; germ cell tumors; SOLID TUMORS; UNITED-STATES; TESTICULAR CANCER; nonseminomas; IFOSFAMIDE PLUS CISPLATIN; INTRATUMORAL HETEROGENEITY; COMBINATION CHEMOTHERAPY; SALVAGE THERAPY; seminomas
• Research Categories: Health Sciences, Oncology; Health Sciences, Medicine and Surgery

Abstract

Purpose of review In the present review, we summarize the recent developments in the management of germ cell tumors (GCTs). Recent findings Treatment-related acute and late-onset toxicity remains a key challenge in the management of GCTs. Recent data show that patients with large retroperitoneal lymph node metastases are at increased risk of venous thromboembolism and may benefit from prophylactic anticoagulation. Predictive models have been developed to identify patients with residual retroperitoneal lymph node masses who are more likely to benefit from surgical resection. However, their clinical use remains hampered by relatively low accuracy. There are currently multiple conventional-dose chemotherapy (CDCT) options for salvage therapy in patients with refractory or recurrent disease. In addition, more efficacious high-dose chemotherapy (HDCT) regimens continue to be developed. The role of salvage CDCT versus HDCT is currently being prospectively investigated. Finally, intratumoral heterogeneity is a common finding in cancer and an obvious observation in GCTs. Despite intratumoral heterogeneity, recent studies on nonseminomatous GCT have identified distinct histological subgroups and a potentially lethal clinical phenotype. Importantly, comprehensive molecular profiling so far has not elucidated the biologic basis or the clinical underpinnings of intratumoral heterogeneity in GCTs. Summary Remaining challenges to be addressed include minimizing therapeutic toxicity and improving outcomes in patients with refractory/recurrent GCTs or malignant transformation of teratomas.