How do you manage a young patient with mediastinal nonseminomatous germ cell tumor that has relapsed after primary treatment with four cycles of VIP?  

Patients with primary mediastinal nonseminomatous germ cell tumors (PMNSGCT) are at poor risk regardless of the size of the tumor or amplitude of AFP. Unfortunately, second-line therapy does very poorly. There would be zero curative value for TIP or VeIP after prior VIP, of course. Despite respectab...