Germ cell tumors (GCTs) are chemosensitive neoplasms with high cure rates; however, a small group of patients present tumors with refractory chemotherapy, with a dismal prognosis and few effective management options. Although immune checkpoint inhibitors (ICIs) are approved for use in chemotherapy refractory GCT, the evidence supporting this indication remains scarce. Original research studies were included on patients with GCTs refractory to chemotherapy treated with ICI up to December 2023. Comprehensive search strategies databases and MeSH keywords were used to locate eligible literature. Study characteristics, participant demographics, and oncological outcomes were recorded. A total of 13 studies (n = 106) were included, five single-patient case reports, one retrospective cohort, six-phase II randomized controlled trials (RCTs), and an abstract from the preliminary results of a phase II RCT. Most of the studies evaluated did not request biomarkers as inclusion criteria. Median overall response rate across studies was 3.4% (range, 0-57) and 0% (range, 0-6) in retrospective cohort and phase II studies. Progressive disease as the best response was present in most patients, with 75% (range, 0-82.9) in the overall population and 82% (range, 75 -83) in the retrospective cohort and phase II trials. Some of the most durable clinical responses documented in this systematic review corresponded to high tumor mutational burden (TMB-H) or high microsatellite instability (MSI-H)/dMMR tumors. Retrospective cohorts and clinical trials evaluating ICIs for the treatment of chemo-refractory GCTs documented limited activity of these drugs as a single intervention in patients not selected by biomarkers, with a tendency to better results described in those with TMB-H or MSI-H/dMMR tumors.
Journal of adolescent and young adult oncology. 2024 Dec 24 [Epub ahead of print]
Carlos Eduardo Salazar-Mejía, Rosalaura Virginia Villarreal-González, Oscar Vidal-Gutiérrez, Carlos de la Cruz-de la Cruz, Estefanía Guadarrama-Rendón, Sofia Alejandra Alvarado-Ruiz, Andrea Sarahi Guerra-Garza, Ramiro Quiroz-Huerta, Karina Alicia Salazar-Salazar, Neri Alejandro Alvarez-Villalobos
Oncology Service, Centro Universitario Contra el Cáncer (CUCC), Hospital Universitario "Dr. José Eleuterio González," Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico., Department of Internal Medicine, Christus Muguerza Hospital Alta Especialidad, Universidad de Monterrey, Monterrey, Mexico., Faculty of Medicine, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico., Facultad de Medicina, Centro de Desarrollo de Investigación 360, Universidad Autónoma de Nuevo León, Monterrey, Mexico.