title: Current Management of Refractory Germ Cell Tumors and Future Directions.
abstract: OBJECTIVE
  We review current management strategies for patients with relapsed and refractory germ cell tumors (GCTs), defined as relapsed or persistent disease following at least one line of cisplatin-based chemotherapy. Additionally, we discuss future directions in the management of these patients.
  
  
  RESULTS
  Recent studies involving targeted therapies have been disappointing. Nevertheless, studies of the management of refractory germ cell cancer are ongoing, with a focus on optimal utilization of high-dose chemotherapy and autologous stem cell transplant, as well as the role of immune checkpoint inhibitors in refractory germ cell tumors. Studies aiming to identify those patients who may benefit from more intensive treatment up front to prevent the development of refractory disease are also in progress. Testicular germ cell tumors are among the most curable of all solid tumor malignancies, with cure being possible even in the refractory, metastatic setting. Treatment of refractory disease remains a challenging clinical scenario, but potentially practice changing studies are ongoing.
authors.affiliation: Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Vanderbilt-Ingram Cancer Center, 691 Preston Research Building, Nashville, TN, 37232, USA.
authors.forename: J Clayton
authors.initials: JC
authors.lastname: Allen
authors.affiliation: Department of Radiation Oncology, Vanderbilt University, Vanderbilt-Ingram Cancer Center, Preston Research Building Room B1003, Nashville, TN, 37232, USA.
authors.forename: Austin
authors.initials: A
authors.lastname: Kirschner
authors.affiliation: Department of Urologic Surgery, Vanderbilt University, A-1302 Medical Center North, Nashville, TN, 37232, USA.
authors.forename: Kristen R
authors.initials: KR
authors.lastname: Scarpato
authors.affiliation: Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Vanderbilt-Ingram Cancer Center, 691 Preston Research Building, Nashville, TN, 37232, USA. alicia.morgans@vanderbilt.edu.
authors.forename: Alicia K
authors.initials: AK
authors.lastname: Morgans
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000627:therapeutic use*; D019468:Disease Management; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000473:pathology
chemical_list: D002945:Cisplatin
keywords: Cisplatin-refractory; Germ cell tumor; Platinum resistant; Refractory; Testicular cancer