How do you approach treatment options for men with germ cell tumors that relapse within 2 years of initial chemotherapy?

In general, patients who relapse more than 3 months out from initial chemotherapy will respond to platinum-based chemotherapy. I prefer TIP regimens x 2 followed by tandem transplant vs TIP x 4 but I will do the latter in patients who do not get approved for transplant or who are not medically cleared. Currently there is the TIGER trial which is addressing this question (transplant vs standard chemo) that I would encourage patients to enroll onto so we can answer this question definitively.