Abstract
The majority of patients with advanced ovarian germ cell cancer are treated by cisplatin-based chemotherapy. Despite adequate first-line treatment, nearly one third of patients relapse and almost half develop cisplatin-resistant disease, which is often fatal. The treatment of cisplatin-resistant disease is challenging and prognosis remains poor. There are limited data on the efficacy of specific chemotherapeutic regimens, high-dose chemotherapy with autologous progenitor cell support and targeted therapies. The inclusion of patients in clinical trials is strongly recommended, especially in clinical trials on the most frequent male germ cell tumors, to offer wider therapeutic opportunities. Here, we provide an overview of current and potential new treatment options including combination chemotherapy, high-dose chemotherapy and molecular targeted therapies, for patients with cisplatin-resistant ovarian germ cell tumors.
Highlights
The European age-standardized incidence rate for female germ cell tumors (GCTs) is 0.4 per 100,000 persons per year [1], whereas that of males is 15-fold higher [2]
In the present review we provide an overview of current options and future prospects for the management of female patients with advanced GCTs, focusing on those who are not cured after first-line chemotherapy and are candidates for salvage treatment
In a phase 2 trial conducted on 18 male patients with CDDP-refractory non-seminomatous GCT treated with oxaliplatin and gemcitabine, 3 (17%) achieved a prolonged complete remission lasting 44, 20 and 18 months, one of whom underwent surgical resection of residual masses, obtaining a disease-free status [67]
Summary
The European age-standardized incidence rate for female germ cell tumors (GCTs) is 0.4 per 100,000 persons per year [1], whereas that of males is 15-fold higher [2]. Yolk sac tumors and choriocarcinomas display morphologies resembling extra-embryonically differentiated tissue The former derive from endodermal sinus and secrete α-fetoprotein (AFP) [8], while the latter are composed of cytotrophoblastic and syncytiotrophoblastic cells that typically express β-hCG, as shown in Table 2 [8,12]. ECs are uncommon among MOGCTs but quite frequent among testicular GCTs (TGCTs) [11] They display features of primitive epithelial cells during the early stages of embryonic development. A multimodality approach regardless of stage IA disease comprising surgery and platinum-based chemotherapy with bleomycin, etoposide and cisplatin (BEP) has obtained 5-year survival rates of up to 100% for dysgerminomas and 85% for non-dysgerminomatous MOGCTs [20,21,22]. In the present review we provide an overview of current options and future prospects for the management of female patients with advanced GCTs, focusing on those who are not cured after first-line chemotherapy and are candidates for salvage treatment
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