Resistant germ cell tumors. Biology and treatment concepts

摘要

abstract_textpResistant germ cell tumors (GCT) are a rare but clinically challenging phenomenon. They should be managed by an interdisciplinary approach, preferably at centres with specialized expertise. Approximately 5-10 of all patients with GCT (20-30 of all patients with metastatic disease at first diagnosis) must undergo salvage chemotherapy because of relapse in the further course of the disease. At best, 50 of these patients can be cured by intensive therapy, including high-dose chemotherapy and resection of residual tumour lesions. Patients relapsing after salvage chemotherapy pose a significant therapeutic problem. New combinations of active substances can achieve long-term survival in 10-15 of these patients. The underlying biology of resistance is poorly understood; however, a defect DNA mismatch-repair system might explain at least some cases. Better molecular characterisation of resistance is necessary to develop targeted treatment strategies./p/abstract_text