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To optimize survival in this group, proper therapy selection throughout the treatment course of poor-risk patients is vital to maximize survival opportunities. Established first-line therapies are available requiring expertise in their selection and toxicity management. Surgical evaluation remains vital for poor-risk patients to address unique disease characteristics seen in this population including multifocal residual disease, extensive mediastinal disease, and brain metastases. Salvage systemic therapies have been developed with several options of conventional and high-dose chemotherapy, requiring expertise in patient selection and treatment delivery. This review discusses the treatment landscape of poor-risk patients, systemic therapy selection, surgical evaluation of patients, treatment of brain metastases, and contemporary management strategies of pertinent clinical scenarios highlighting the multidisciplinary approach needed to optimize cure rates in this group.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/edbk-26-516212","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T19:59:09Z","timestamp":1778788749000},"source":"Crossref","is-referenced-by-count":2,"title":["How to Optimize Treatment for Patients With Poor-Risk Testicular Cancer"],"prefix":"10.1200","volume":"46","author":[{"given":"Noah","family":"Richardson","sequence":"first","affiliation":[{"name":"Division of Hematology &amp; Medical Oncology\u2014Melvin &amp; Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alok K.","family":"Tewari","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrizia","family":"Giannatempo","sequence":"additional","affiliation":[{"name":"Department of Genitourinary Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael F.","family":"Basin","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amedeo","family":"Nuzzo","sequence":"additional","affiliation":[{"name":"Department of Genitourinary Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Mascaro","sequence":"additional","affiliation":[{"name":"Fondazione IRCCS Policlinico San Matteo, Pavia, Italy"},{"name":"Universit\u00e0 degli Studi di Pavia, Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren R.","family":"Feldman","sequence":"additional","affiliation":[{"name":"Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8905-8329","authenticated-orcid":true,"given":"Nabil","family":"Adra","sequence":"additional","affiliation":[{"name":"Division of Hematology &amp; Medical Oncology\u2014Melvin &amp; Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siamak","family":"Daneshmand","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"e_1_3_2_2_2","unstructured":"National Cancer Institute: Cancer stat facts: Testicular cancer. 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