Germ Cell Tumors: Looking to the Future

Abstract

Our knowledge about the management of men with germ cell tumors (GCTs) and its tumor biology continues to evolve. Vascular disease, metabolic syndrome, second malignant neoplasms, and hypogonadism occur after treatment for GCTs and the latency pattern resembles that seen in patients treated for Hodgkin lymphoma. Patients receiving treatment for GCTs should be informed not only of the near-term toxicity (experienced during or shortly after administration), but also the delayed and late effects of chemotherapy and the need for lifelong surveillance for all late outcomes, including late relapse. Recent data suggest that the treatment outcome of patients with intermediate-risk, poor-risk, and relapsed GCTs can be improved through multicenter trials that include the general oncology community. Finally, GCTs are a malignancy of primordial germ cells. Programmed differentiation is clinically evident in vivo and probably related to chemotherapy resistance. This biology has much clinical relevance, some of which is already in use.