Updates on Germ Cell Tumors with David Gershenson

In this episode of the IJGC podcast, Editor-in-Chief, Dr. Pedro Ramirez, is joined by Dr. David M. Gershenson to discuss updates on germ cell tumors. Dr. Gershenson is Professor and former Chair of the Department of Gynecologic Oncology and Reproductive Medicine at The University of Texas MD Anderson Cancer Center. His major focus is on the clinical and translational research or rare ovarian cancers. Highlights: - The treatment of malignant ovarian germ cell tumor has evolved over the last 5 decades to represent one of our most remarkable success stories, with cure in 95+% of patients with stage I/II and approximately 75% of patients with stage III/IV. - AGCT1531 is a very important trial, which, if positive, will reduce toxicity by extending surveillance to patients with stage IA or IB malignant ovarian germ cell tumors, including grade 2 and 3 immature teratomas, yolk sac tumors, and non-gestational choriocarcinomas and will result in the substitution of carboplatin for cisplatin in the regimen for treatment of stage IC-III. - Fertility-sparing surgery is possible in the majority of young patients with malignant ovarian germ cell tumor, related to the following: a) 95% are confined to one ovary ; b) approximately 2/3s are stage I; and c) most patients are in their teenage years, 20s, and 30s and have not completed childbearing. - Major controversies differentiating the treatment of children and adults by pediatric oncologists/pediatric surgeons and gynecologic oncologists, respectively, include the extent of surgical staging and the role of postoperative chemotherapy in patients with pure immature teratoma. - For patients with malignant ovarian germ cell tumors who recur following primary therapy, BEP is recommended for those who have been treated with surgery alone. For those who have previously received BEP, standard management generally includes high-dose chemotherapy with stem cell rescue.

- Aspects of management of malignant ovarian germ cell tumors that require further study include the role of neoadjuvant chemotherapy and the role of secondary cytoreductive surgery.