Male germ cell tumors, of which testicular is the most common, are rare but generally highly curable malignancies. Cure rates in the metastatic setting are among the highest for any solid tumor, although outcomes in the poor-risk subgroup remain suboptimal. Although most men are cured, risk prognostication tools have identified poor-risk patients with inferior outcomes leading to significant mortality in this predominantly young patient population. To optimize survival in this group, proper therapy selection throughout the treatment course of poor-risk patients is vital to maximize survival opportunities. Established first-line therapies are available requiring expertise in their selection and toxicity management. Surgical evaluation remains vital for poor-risk patients to address unique disease characteristics seen in this population including multifocal residual disease, extensive mediastinal disease, and brain metastases. Salvage systemic therapies have been developed with several options of conventional and high-dose chemotherapy, requiring expertise in patient selection and treatment delivery. This review discusses the treatment landscape of poor-risk patients, systemic therapy selection, surgical evaluation of patients, treatment of brain metastases, and contemporary management strategies of pertinent clinical scenarios highlighting the multidisciplinary approach needed to optimize cure rates in this group.
American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting. 2026 May 14 [Epub]
Noah Richardson, Alok K Tewari, Patrizia Giannatempo, Michael F Basin, Amedeo Nuzzo, Federica Mascaro, Darren R Feldman, Nabil Adra, Siamak Daneshmand
Division of Hematology & Medical Oncology-Melvin & Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN., Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA., Department of Genitourinary Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Department of Urology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA., Fondazione IRCCS Policlinico San Matteo, Pavia, Italy., Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.