Cisplatin-refraktäre Keimzelltumoren

Background: Despite the generally excellent cure rate of testicular germ cell tumors, the prognosis for patients with cisplatin-refractory tumors remains very unfavorable. Objective: To provide an overview of resistance mechanisms, established treatment options, novel therapeutic targets and possible targeted treatment approaches. Material and methods: PubMed, MEDLINE and EMBASE were comprehensively searched to identify original articles, clinical trials and reviews regarding cisplatin-refractory germ cell tumors published between 1990 and 2016. The ASCO and ESMO conference proceedings from 2013 to 2016 were also searched to identify unpublished results of ongoing trials. Results: The mechanisms of cisplatin resistance are manifold. Patients who fail first-line treatment, suffer multiple relapses or a relapse after high-dose chemotherapy only have very limited treatment options and in most cases only palliation can be achieved. Gemcitabine, oxaliplatin, paclitaxel and oral etoposide have been shown to have limited efficacy as single agents. The triple combination GOP regimen can achieve sustained remission in approximately 15% of patients, particularly when combined with secondary surgical resection of all residual lesions. Targeted treatment approaches do not currently play a role in treatment of testicular germ cell tumors. Conclusion: Cisplatin-refractory germ cell tumors are clinically challenging and require multimodal treatment concepts at expert centers to achieve long-term remission in a subset of patients. The potential of new treatment approaches, e. g. with cabazitaxel or targeting of the PD-1/PD-L1 axis are the subject of currently ongoing clinical studies.