Children’s Oncology Group’s 2023 blueprint for research: Germ cell tumors

Bhuta R, Shah R, Gell JJ, Poynter JN, Bagrodia A, Dicken BJ, Pashankar F, Frazier AL, Shaikh F. Children’s Oncology Group’s 2023 blueprint for research: Germ cell tumors. Pediatr Blood Cancer. 2023 Sep;70 Suppl 6(Suppl 6):e30562. doi: 10.1002/pbc.30562. Epub 2023 Jul 14. PubMed PMID: 37449938; PubMed Central PMCID: PMC10529374.

Extracranial germ cells tumors (GCT) are a biologically diverse group of tumors occurring in children, adolescents, and young adults. The majority of patients have excellent outcomes, but treatment-related toxicities impact their quality of survivorship. A subset of patients succumbs to the disease. Current unmet needs include clarifying which patients can be safely observed after initial surgical resection, refinement of risk-stratification to reduce chemotherapy burden in patients with standard-risk disease, and intensify therapy for patients with poor-risk disease. Furthermore, enhancing strategies for detection of minimal residual disease and early detection of relapse, particularly in serum tumor marker-negative histologies, is critical. Improving the understanding of the developmental and molecular origins of GCTs may facilitate discovery of novel targets. Future efforts should be directed towards assessing novel therapies in a biology-driven, biomarker-defined, histology-specific, risk-stratified patient population. Fragmentation of care between subspecialists restricts the unified study of these rare tumors. It is imperative that trials be conducted in collaboration with national and international cooperative groups, with harmonized data and biospecimen collection. Key priorities for the COG GCT Committee include a) better understanding the biology of GCTs with a focus on molecular targets and mechanisms of treatment resistance, b) strategic development of pediatric and young adult clinical trials, c) understanding late effects of therapy and identifying individuals most at risk, and d) prioritizing diversity, equity, and inclusion to reduce cancer health disparities and studying the impacts of social determinants of health on outcomes.