Cisplatinrefraktäre Keimzelltumoren – molekulare Grundlagen und klinische Konzepte

Background: Despite excellent cure rates due to platinum-based combination chemotherapy in advanced stages, 10–15% of germ cell tumour (GCT) patients display a cisplatin-refractory disease and have a dismal prognosis. Objectives: An overview on the molecular background, current treatment approaches, and potential future options for cisplatin refractory GCTs is provided. Materials and methods: The present review is based on a literature search of articles published in PubMed and MEDLINE (1990–2020), as well as conference abstracts of the American Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO) and Deutsche Gesellschaft für Hämatologie und Medizinische Onkologie (DGHO) annual meetings (2015–2020). Results: The development of cisplatin resistance is a multifactorial phenomenon. Therefore, treatment options after failure of cisplatin-based combination chemotherapy are very limited. Targeted treatment approaches, i.e. immune checkpoint inhibition or tyrosine kinase inhibition do not play a role in the management of refractory GCT due to their insufficient effectiveness. Hence, conventional chemotherapy remains the standard of care. With a response rate of about 50%, the most promising activity has been reported for the combination of gemcitabine, oxaliplatin and paclitaxel (GOP) Conclusions: The treatment of cisplatin-refractory GCTs remains severely challenging for oncologists and patients should be treated at specialized centers. Future translational studies are urgently needed to identify novel therapeutic targets and individual treatment approaches to improve outcomes.