Chemotherapy for Extracranial Germ Cell Tumours in Paediatric, Adolescent, and Young Adult Patients

Abstract

Extracranial germ cell tumours (GCT) are derived from dysregulated, unipotent to totipotent, primordial germ cells and can arise from heterogeneous sites and occur across a broad age range of patients. Although healthcare professionals in the paediatric and adult medical fields collaborate closely, discrepancies in the staging system and risk-assignment used still exist. Treatment outcomes are worst in adolescent patient groups. Surgical principles have been established for treatment at initial diagnosis and during salvage therapy, as well as for the most difficult circumstances, termed desperation surgery. The development of cisplatin-containing chemotherapy marked the 1st success in GCT treatment, representing one of the major advances in the last 50 years of modern oncology. Nowadays, first-line three-drug chemotherapy regimens use cisplatin, etoposide, and either bleomycin or ifosfamide. Paediatric chemotherapy regimens typically reduce the use of bleomycin or replace cisplatin with carboplatin to decrease the levels of toxic agents in developing children. New targeted chemo-agents have been explored as potential options for refractory and relapsed GCT, as well as non-GCT malignant transformation. Here, the chemotherapy regimens currently used by paediatric and adult oncologists are described. The recent progress in targeted chemo-agents that are being used in the clinic is also discussed. Hopefully, through appropriate delivery of targeted chemo-agents, combined with well-established surgical procedures, the best outcomes of GCT for every age population can be achieved at initial diagnosis and for relapsed/refractory GCT and non-GCT transformation.