Carbonnaux Mélodie, Vinceneux Armelle, Peyrat Patrice, Fléchon Aude
Département d'oncologie médicale, centre Léon-Bérard, 28, rue Laennec, 69337 Lyon cedex 08, France.
Département d'oncologie médicale, centre Léon-Bérard, 28, rue Laennec, 69337 Lyon cedex 08, France.
Bull Cancer. 2020 Sep;107(9):912-924. doi: 10.1016/j.bulcan.2020.03.012. Epub 2020 Jul 8.
Seminomatous (SGCT) and non-seminomatous (NSGCT) germ cell tumors (GCT) are rare but their incidence are increasing. We will discuss different therapeutic strategies in relapse disease: patients with stage I germ cell tumor have an excellent prognosis with a cure rate approaching 98-99 %, whatever the histology and the chosen treatment (surveillance strategy or adjuvant treatment). Relapses are observed among 20% of patients with stage I SGCT or low risk NSGCT and 50 % of patients with high risk NSGCT. Patients are treated according to the international prognosis group (IGCCCG) for SGCT and low risk NSGCT, naïve of chemotherapy. After an adjuvant treatment, the protocol must be adapted to the number of previous cycles (1 or 2 BEP) and to the prognosis group. Five to 50% of patients relapse after a first line of metastatic chemotherapy according to initial prognosis group. Dose-dense chemotherapy according to the GETUG13 protocol reduces the risk of relapse for the patients with poor-risk group NSGCT and unfavorable tumor marker decline. The prognosis of patients with relapsed or refractory GCT after a first line is more negative since only half of them will be cured by salvage standard chemotherapy. An international therapeutic trial (TIGER) is ongoing in first line salvage treatment evaluating high-dose chemotherapy (HDCT) with hematopoietic stem cell transplantation (HSCT). Finally, developing biomarkers for predicting clinical relapse, the management in expert centers of these patients and participation in therapeutic innovation are important perspectives for a better understanding and treatment of these patients with a poorer prognosis.
精原细胞瘤（SGCT）和非精原细胞瘤（NSGCT）性生殖细胞肿瘤（GCT）较为罕见，但发病率呈上升趋势。我们将讨论复发性疾病的不同治疗策略：无论组织学类型和所选治疗方法（监测策略或辅助治疗）如何，I期生殖细胞肿瘤患者的预后都非常好，治愈率接近98-99%。20%的I期SGCT或低风险NSGCT患者以及50%的高风险NSGCT患者会出现复发。对于SGCT和低风险NSGCT患者，根据国际预后分组（IGCCCG）进行治疗，不进行化疗。辅助治疗后，治疗方案必须根据先前化疗周期的数量（1或2个BEP方案）和预后分组进行调整。根据初始预后分组，5%至50%的患者在一线转移性化疗后会复发。根据GETUG13方案进行的剂量密集化疗可降低高风险组NSGCT患者和肿瘤标志物下降不理想患者的复发风险。一线治疗后复发或难治性GCT患者的预后更差，因为只有一半的患者能通过挽救性标准化疗治愈。一项国际治疗试验（TIGER）正在进行一线挽救治疗，评估造血干细胞移植（HSCT）联合大剂量化疗（HDCT）。最后，开发预测临床复发的生物标志物、在专家中心对这些患者进行管理以及参与治疗创新，对于更好地理解和治疗这些预后较差的患者具有重要意义。
