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Diagnosis and treatment of relapsed and refractory testicular germ cell tumors

Timothy D Gilligan, MD
Philip W Kantoff, MD
Section Editor
William K Oh, MD
Deputy Editor
Michael E Ross, MD


Testicular germ cell tumors (GCTs) have become one of the most curable solid neoplasms because of remarkable treatment advances that began in the late 1970s.

Prior to the development of effective chemotherapy regimens, the five-year survival rate among men with testicular GCTs was 64 percent [1]. Currently, the five-year survival rate is over 95 percent for both seminomas and nonseminomatous germ cell tumors (NSGCTs) in the United States and Europe. There are approximately 8850 cases of testicular cancer diagnoses and 400 deaths annually from testicular cancer in the United States [2]. Worldwide, there are approximately 72,000 cases and 9000 deaths annually [3].

Chemotherapy in patients with extragonadal GCTs (mainly mediastinal or retroperitoneal tumors) is generally based upon the experience in men with testicular GCTs, and these patients are often included in clinical trials. (See "Extragonadal germ cell tumors involving the mediastinum and retroperitoneum".)

Cisplatin-based combination chemotherapy can cure patients with disseminated GCTs, even in the context of widespread visceral metastases, highly elevated serum tumor markers, and other adverse prognostic features. In contrast to the excellent outcomes for men with good-risk advanced testicular GCTs (over 80 percent relapse-free survival following first-line chemotherapy), up to 60 percent of men who have features of intermediate- or poor-risk disease require additional therapy for relapsed disease following first-line chemotherapy (table 1) [4-7]. (See "Initial risk-stratified treatment for advanced testicular germ cell tumors", section on 'Definition of risk'.)

While most men with metastatic germ cell tumors are cured with first line chemotherapy, the cure rate for germ cell tumors that relapse after first line chemotherapy for metastatic disease is much lower. Men who are diagnosed with relapsed or refractory testicular GCTs should be referred to a cancer center with multidisciplinary expertise, and patients should be offered the opportunity to participate in clinical studies whenever possible. The management of men who progress during chemotherapy or relapse following treatment for GCTs will be reviewed here. The use of chemotherapy to treat patients with advanced chemotherapy-naïve disease is discussed elsewhere. (See "Overview of the treatment of testicular germ cell tumors" and "Initial risk-stratified treatment for advanced testicular germ cell tumors".)

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Literature review current through: Nov 2017. | This topic last updated: Oct 19, 2017.
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