Poor prognosis germ-cell tumors: An unresolved challenge.

The prognostic classification developed by the International Germ Cell Consensus group (IGCCC) enables appropriate choice of initial treatment, and provides consistent eligibility criteria for clinical trials and more accurate assessment of published results. The standard therapy for IGCCC poor- and intermediate-prognosis germ-cell tumors is 4 cycles of bleomycin, etoposide, and cisplatin chemotherapy followed by surgical resection of residual masses, if the serum tumor markers have returned to normal. Improved outcomes are achieved by centers that treat a larger number of cases. The unsatisfactory results achieved with current therapy warrant entry of these patients into appropriate clinical trials. Future improvements in therapy are likely to require a better understanding of the molecular mechanisms of resistance and the development of novel therapeutic approaches that target these mechanisms.