Nab-PTX, Ifosfamide and Cisplatin in the Treatment of Pediatric Extracranial Germ Cell Tumor.

Inclusion Criteria:

1. Age: 1-18 years old;

2. ECOG PS score: 0-1;

3. Patients was confirmed pathologically with malignant germ cell tumor.

4. Patients with tumor progressed, relapsed or refractory after first-line chemotherapy,and complete or partial remission was not achieved after recent treatment.

5. Have at least one measurable lesion defined by RECIST standard;

6. The estimated survival time was more than 6 months;

7. Patients must fully recover from the acute toxicity of previous anticancerchemotherapy:

8. Bone marrow function met the following criteria:

9. Absolute neutrophil count (ANC) ≥ 1.0 × 109 / L;

10. Platelet count ≥ 100.0 × 109 / L (not after platelet transfusion);

11. Liver and kidney function should meet the following criteria:

12. Bilirubin (the sum of bound and unconjugated) ≤ 1.5 × upper limit of normal value (ULN) (corresponding to age). Patients with confirmed Gilbert's syndrome can beclassified according to the researcher;

13. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 2.5 × ULN;

14. Estimated glomerular filtration rate ≥ 70 ml / min / 1.73 m2 or normal serumcreatinine (CR);

15. Adequate pulmonary function: no dyspnea at rest, no exercise intolerance, pulse oxygensaturation > 94% (if there are clinical symptoms);

16. Cardiac function:

17. LVEF ≥ 50% was detected by echocardiography;

18. There was no history of arrhythmia requiring drug intervention before enrollment;

19. Seizures that can be fully controlled without enzyme-induced anticonvulsants;

20. During the study period, they were able to comply with outpatient treatment,laboratory monitoring and necessary clinical visits;

21. Parents / guardians of child or adolescent subjects have the ability to understand,agree and sign the study informed consent form (ICF) and the applicable child consentform before starting any program related procedures; subject has the ability toexpress consent (when applicable) with the consent of parents / guardians.

Exclusion Criteria: Patients with any of the following items will not be enrolled in this study:

1. Patients with recurrent germ cell tumor were treated by surgery alone previously;

2. Patients with immature teratoma (any grade);

3. Patients with sex cord stroma;

4. HBsAg positive patients;

5. Patients with HIV or syphilis infection;

6. Patients who had received organ transplantation before;

7. Uncontrolled active systemic bacterial, viral or fungal infections;