(Urotoday.com) To provide a context to the keynote lecture by Dr. Andrea Necchi discussing the management of chemotherapy-resistant germ cell tumors at the inaugural Global Society of Rare Genitourinary Tumors virtual summit, Dr. Lucia Nappi provided a commentary discussion of this topic. By way of background, Dr. Nappi notes that 20-30% of patients will relapse after first-line therapy, and the prognosis after second-line therapy is less favorable, with only 15-30% of patients maintaining a continued disease-free rate. Most studies in this disease space are non-randomized, small, and include a heterogeneous population. Very few randomized studies have shown a higher benefit of sequential salvage high-dose chemotherapy than a single consolidating high-dose chemotherapy cycle after three standard doses. Furthermore, there is a lack of clinical/biological predictive markers for appropriate patient selection.