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Kim GY, Conduit C, O'Haire S, Chong CY, Baenziger O, Lewin J, Thomas B, Lawrentschuk N, Stockler MR, Olver I, Grimison P, Tran B. Association between low total serum testosterone and body mass index in Australian survivors of testicular cancer: a retrospective analysis. Basic Clin Androl 2024; 34:14. [PMID: 39223491 PMCID: PMC11369996 DOI: 10.1186/s12610-024-00230-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 07/01/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Primary hypogonadism is a recognised complication in survivors of testicular cancer. However, secondary hypogonadism can result from other causes that suppress the hypothalamic-pituitary axis, including obesity, high dose glucocorticoids, chronic end organ failure, and diabetes. The aim of this study was to explore low total serum testosterone in Australian survivors of testicular cancer and examine associations with body mass index, age, and prior chemotherapy use. METHODS Clinical data including height, weight, diagnosis, treatment, and hormonal evaluations during follow-up were extracted from the Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group Chemocog study (2007-2012), accompanied by data from two Australian, high-volume testicular cancer centres included in the iTestis testicular cancer registry (2012-2019). Low testosterone was defined by a serum concentration of testosterone (T) < 10 nmol/L, and was classified as primary by a serum concentration of luteinising hormone (LH) > 8 IU/L, otherwise as secondary. RESULTS Two hundred eighty-five individuals with either stage 1 or advanced testicular cancer were included. Of these, 105 (37%) were treated with orchidectomy and chemotherapy. Forty-nine (17%) met criteria for low testosterone during follow-up: 21 (43%) had primary and 27 (55%) had secondary low testosterone. Survivors of testicular cancer with higher body mass index were more likely to display low testosterone, both primary (p = 0.032) and secondary (p = 0.028). Our data did not show evidence of an association between older age or chemotherapy use and low testosterone in our cohort. CONCLUSIONS Low total serum testosterone was common in survivors of testicular cancer, and associated with a higher body mass index prior to orchidectomy, suggesting that elevated body mass index may contribute to low testosterone in this population, and that body weight, diet, and exercise should be addressed in testicular cancer follow-up.
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Affiliation(s)
- Grace Y Kim
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.
| | - Ciara Conduit
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Sophie O'Haire
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Chia Yuen Chong
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Olivia Baenziger
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Jeremy Lewin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
- ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Parkville, VIC, Australia
| | - Benjamin Thomas
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Epworth Freemasons Hospital, Melbourne, VIC, Australia
| | - Martin R Stockler
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
- Concord Repatriation General Hospital, Sydney, NSW, Australia
- Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Ian Olver
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Barangaroo, NSW, Australia
| | - Peter Grimison
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
- Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Ben Tran
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
- Epworth Freemasons Hospital, Melbourne, VIC, Australia
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2
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Li Z, Ding X, Chen Y, Keaver L, Champ CE, Fink CL, Lebovits SC, Corroto M, Zhang FF. Review of Nutrition Guidelines and Evidence on Diet and Survival Outcomes for Cancer Survivors: Call for Integrating Nutrition into Oncology Care. J Nutr 2024; 154:2346-2362. [PMID: 38797479 DOI: 10.1016/j.tjnut.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/13/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024] Open
Abstract
Several organizations have published nutrition guidelines for cancer survivors during and after treatment. This review compared nutrition guidelines for cancer survivors published in the United States for the topics that are covered in the guidelines and evaluated the evidence that these guidelines are based upon. A team of researchers, patient stakeholders, and healthcare providers collectively identified 5 nutrition guidelines for cancer survivors in the United States: the 2022 American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors, the 2018 American Institute for Cancer Research Cancer Nutrition Guide, the 2022 National Cancer Institute Physician Data Query and Eating Hints, the 2024 National Comprehensive Cancer Network Guidelines for Cancer Survivors, and the 2020 American Society for Clinical Oncology Guidelines. The 5 guidelines cover a comprehensive list of nutrition topics but overall promote to follow those recommendations for cancer prevention. This review also evaluated the current evidence from meta-analyses on dietary patterns and intakes of foods and nutrients in relation to survival outcomes among cancer survivors. Although the evidence on dietary patterns is strong, the evidence on most dietary factors is still limited and the current research was primarily conducted among breast and colorectal cancer survivors. Although nutrition recommendations are available for cancer survivors, practical strategies need to be implemented to integrate nutrition into oncology care and help cancer survivors follow these recommendations. Further research is warranted to provide additional evidence on the role of nutrition in the health outcomes of cancer survivors and guide the development of evidence-based nutrition recommendations. The protocol is registered in PROSPERO: CRD42023429240.
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Affiliation(s)
- Zhongyao Li
- Division of Nutrition Epidemiology and Data Sciences, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Xinge Ding
- Division of Nutrition Epidemiology and Data Sciences, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States; Frances Stern Nutrition Center, Tufts Medical Center, Boston, MA, United States
| | - Yutong Chen
- Division of Nutrition Epidemiology and Data Sciences, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Laura Keaver
- Department of Health and Nutritional Science, Atlantic Technological University Sligo, Sligo, Ireland
| | - Colin E Champ
- Department of Radiation Oncology and Exercise Oncology and Resiliency Center, Allegheny Health Network, Pittsburgh, PA, United States
| | - Christopher L Fink
- Department of Health and Human Kinetics, Ohio Wesleyan University, Delaware, OH, United States
| | | | - Mark Corroto
- Fear(less) Survivors, Delaware, OH, United States
| | - Fang Fang Zhang
- Division of Nutrition Epidemiology and Data Sciences, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States.
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3
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Arranz Arija JA, Del Muro XG, Caro RL, Méndez-Vidal MJ, Pérez-Valderrama B, Aparicio J, Climent Durán MÁ, Caballero Díaz C, Durán I, González-Billalabeitia E. SEOM-GG clinical guidelines for the management of germ-cell testicular cancer (2023). Clin Transl Oncol 2024:10.1007/s12094-024-03532-2. [PMID: 38958901 DOI: 10.1007/s12094-024-03532-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 07/04/2024]
Abstract
Testicular germ cell tumors are the most common tumors in adolescent and young men. They are curable malignancies that should be treated with curative intent, minimizing acute and long-term side effects. Inguinal orchiectomy is the main diagnostic procedure, and is also curative for most localized tumors, while patients with unfavorable risk factors for recurrence, or those who are unable or unwilling to undergo close follow-up, may require adjuvant treatment. Patients with persistent markers after orchiectomy or advanced disease at diagnosis should be staged and classified according to the IGCCCG prognostic classification. BEP is the most recommended chemotherapy, but other schedules such as EP or VIP may be used to avoid bleomycin in some patients. Efforts should be made to avoid unnecessary delays and dose reductions wherever possible. Insufficient marker decline after each cycle is associated with poor prognosis. Management of residual masses after chemotherapy differs between patients with seminoma and non-seminoma tumors. Patients at high risk of relapse, those with refractory tumors, or those who relapse after chemotherapy should be managed by multidisciplinary teams in experienced centers. Salvage treatment for these patients includes conventional-dose chemotherapy (TIP) and/or high-dose chemotherapy, although the best regimen and strategy for each subgroup of patients is not yet well established. In late recurrences, early complete surgical resection should be performed when feasible. Given the high cure rate of TGCT, oncologists should work with patients to prevent and identify potential long-term side effects of the treatment. The above recommendations also apply to extragonadal retroperitoneal and mediastinal tumors.
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Affiliation(s)
| | - Xavier García Del Muro
- Hospital Duran I Reynals, Institut Català D'Oncologia L'Hospitalet (ICO), Barcelona, Spain
| | - Raquel Luque Caro
- Hospital Universitario Virgen de Las Nieves, Instituto de Investigación Biosanitaria Ibs, Granada, Spain
| | | | | | - Jorge Aparicio
- Hospital Universitario I Politècnic La Fe, Valencia, Spain
| | | | | | - Ignacio Durán
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
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4
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Vrouwe JPM, Hennus PML, Hamdy NAT, Osanto S, Willemse PM. Risk of osteoporosis in testicular germ cell tumour survivors: A systematic review of the literature. BJUI COMPASS 2023; 4:24-43. [PMID: 36569500 PMCID: PMC9766871 DOI: 10.1002/bco2.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 06/26/2022] [Accepted: 07/10/2022] [Indexed: 12/27/2022] Open
Abstract
Context Testicular germ cell tumour (TGCT) survivors are potentially at risk of developing osteoporosis, because of increased risk for disturbed bone remodelling associated with hypogonadism and anti-cancer treatment. A number of studies show bone loss and increased fracture risk in TGCT survivors, but data are scarce. There are no clinical guidelines or recommendations issued to address skeletal health in this group of patients potentially at high risk for osteoporosis. Objective To conduct a systematic review of available literature addressing bone health in TGCT patients. Subgroup analysis was performed to identify risk factors for bone loss and increased fracture risk. Evidence Acquisition Relevant databases, including MEDLINE, Embase and the Cochrane Library, including all English written comparative studies addressing bone health in TGCT patients, were searched up to December 2021 and a narrative synthesis was undertaken. Risk of bias (RoB) was assessed using Cochrane ROBINS-I tool. Evidence Synthesis Ten studies (eight cross-sectional and two longitudinal), recruiting a total of 1997 unique TGCT patients, were identified and included in the analysis. Bone health was reported in various ways in different studies, and subgroups were defined heterogeneously, resulting in a widely varying prevalence of osteoporosis of up to 73.2% of patients. Six studies reported low BMD associated with higher luteinizing hormone levels and one study showed a correlation between follow up duration and bone loss. Conclusions TGCT survivors are at risk of developing osteoporosis and sustaining fragility fractures. Chemotherapy, pituitary-gonadal axis dysfunction and ageing are key risk factors, although available data are scarce. With increasing survival of TGCT patients, a clear unmet need has been identified to systematically evaluate and monitor skeletal health in larger numbers of survivors in order to develop best clinical practice guidelines to manage the insidious but potentially preventable and treatable skeletal complications of TGCT.
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Affiliation(s)
- Josephina P. M. Vrouwe
- Department of Medical OncologyLeiden University Medical CentreLeidenThe Netherlands
- Centre for Human Drug ResearchLeidenThe Netherlands
| | - Pauline M. L. Hennus
- Department of UrologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
- Department of UrologyAmphia HospitalBredaThe Netherlands
| | - Neveen A. T. Hamdy
- Department of Medicine, Division of Endocrinology, and Center for Bone QualityLeiden University Medical CentreLeidenThe Netherlands
| | - Susanne Osanto
- Department of Medical OncologyLeiden University Medical CentreLeidenThe Netherlands
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5
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Miller KD, Nogueira L, Devasia T, Mariotto AB, Yabroff KR, Jemal A, Kramer J, Siegel RL. Cancer treatment and survivorship statistics, 2022. CA Cancer J Clin 2022; 72:409-436. [PMID: 35736631 DOI: 10.3322/caac.21731] [Citation(s) in RCA: 975] [Impact Index Per Article: 487.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 12/12/2022] Open
Abstract
The number of cancer survivors continues to increase in the United States due to the growth and aging of the population as well as advances in early detection and treatment. To assist the public health community in better serving these individuals, the American Cancer Society and the National Cancer Institute collaborate triennially to estimate cancer prevalence in the United States using incidence and survival data from the Surveillance, Epidemiology, and End Results cancer registries, vital statistics from the Centers for Disease Control and Prevention's National Center for Health Statistics, and population projections from the US Census Bureau. Current treatment patterns based on information in the National Cancer Database are presented for the most prevalent cancer types by race, and cancer-related and treatment-related side-effects are also briefly described. More than 18 million Americans (8.3 million males and 9.7 million females) with a history of cancer were alive on January 1, 2022. The 3 most prevalent cancers are prostate (3,523,230), melanoma of the skin (760,640), and colon and rectum (726,450) among males and breast (4,055,770), uterine corpus (891,560), and thyroid (823,800) among females. More than one-half (53%) of survivors were diagnosed within the past 10 years, and two-thirds (67%) were aged 65 years or older. One of the largest racial disparities in treatment is for rectal cancer, for which 41% of Black patients with stage I disease receive proctectomy or proctocolectomy compared to 66% of White patients. Surgical receipt is also substantially lower among Black patients with non-small cell lung cancer, 49% for stages I-II and 16% for stage III versus 55% and 22% for White patients, respectively. These treatment disparities are exacerbated by the fact that Black patients continue to be less likely to be diagnosed with stage I disease than White patients for most cancers, with some of the largest disparities for female breast (53% vs 68%) and endometrial (59% vs 73%). Although there are a growing number of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based strategies and equitable access to available resources are needed to mitigate disparities for communities of color and optimize care for people with a history of cancer. CA Cancer J Clin. 2022;72:409-436.
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Affiliation(s)
| | - Leticia Nogueira
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Theresa Devasia
- Data Analytics Branch, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Angela B Mariotto
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - K Robin Yabroff
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Joan Kramer
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance Research, American Cancer Society, Atlanta, Georgia
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6
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Shrem NS, Wood L, Hamilton RJ, Kuhathaas K, Czaykowski P, Roberts M, Matthew A, Izard JP, Chung P, Nappi L, Jones J, Soulières D, Aprikian A, Power N, Canil C. Testicular cancer survivorship: Long-term toxicity and management. Can Urol Assoc J 2022; 16:257-272. [PMID: 35905486 PMCID: PMC9343164 DOI: 10.5489/cuaj.8009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
- Noa Shani Shrem
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Lori Wood
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Robert J. Hamilton
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kopika Kuhathaas
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Piotr Czaykowski
- Department of Medical Oncology and Hematology, CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Matthew Roberts
- Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Andrew Matthew
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jason P. Izard
- Departments of Urology and Oncology, Queen’s University, Kingston, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Health Network, University of Toronto, Toronto, ON, Canada
| | - Lucia Nappi
- Division of Medical Oncology, British Columbia Cancer - Vancouver Cancer Centre, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Jones
- Department of Supportive Care, Princess Margaret Cancer Centre, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Denis Soulières
- Division of Medical Oncology/Hematology, Le Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Armen Aprikian
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Nicholas Power
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Christina Canil
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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7
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Leitner BP, Siebel S, Akingbesote ND, Zhang X, Perry RJ. Insulin and cancer: a tangled web. Biochem J 2022; 479:583-607. [PMID: 35244142 PMCID: PMC9022985 DOI: 10.1042/bcj20210134] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 12/13/2022]
Abstract
For a century, since the pioneering work of Otto Warburg, the interwoven relationship between metabolism and cancer has been appreciated. More recently, with obesity rates rising in the U.S. and worldwide, epidemiologic evidence has supported a link between obesity and cancer. A substantial body of work seeks to mechanistically unpack the association between obesity, altered metabolism, and cancer. Without question, these relationships are multifactorial and cannot be distilled to a single obesity- and metabolism-altering hormone, substrate, or factor. However, it is important to understand the hormone-specific associations between metabolism and cancer. Here, we review the links between obesity, metabolic dysregulation, insulin, and cancer, with an emphasis on current investigational metabolic adjuncts to standard-of-care cancer treatment.
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Affiliation(s)
- Brooks P. Leitner
- Departments of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, U.S.A
- Departments of Internal Medicine, Yale School of Medicine, New Haven, CT, U.S.A
| | - Stephan Siebel
- Departments of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, U.S.A
- Departments of Internal Medicine, Yale School of Medicine, New Haven, CT, U.S.A
- Departments of Pediatrics, Yale School of Medicine, New Haven, CT, U.S.A
| | - Ngozi D. Akingbesote
- Departments of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, U.S.A
- Departments of Internal Medicine, Yale School of Medicine, New Haven, CT, U.S.A
| | - Xinyi Zhang
- Departments of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, U.S.A
- Departments of Internal Medicine, Yale School of Medicine, New Haven, CT, U.S.A
| | - Rachel J. Perry
- Departments of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, U.S.A
- Departments of Internal Medicine, Yale School of Medicine, New Haven, CT, U.S.A
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8
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Barnett TL. From Cancer Patient to Provider: An Autobiographical Case Report. Cureus 2021; 13:e20764. [PMID: 35111449 PMCID: PMC8794429 DOI: 10.7759/cureus.20764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 11/15/2022] Open
Abstract
Testicular cancer is considered to be the model for the curable neoplasm, with outcomes improving from nearly universal fatality to nearly universal cure in the matter of two decades, driven largely in part by the accidental discovery and application of platinum chemotherapy. Such a diagnosis and treatment can have significant and long-lasting effects on patients, although with every such experience come learning opportunities. This autobiographical case report describes the author’s experience being diagnosed with testicular cancer, the challenges faced during treatment and survivorship, the lessons learned being a patient, and the way they guided him on his path to his current role as an adolescent and young adult (AYA) oncologist.
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9
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Gernier F, Ahmed-Lecheheb D, Pautier P, Floquet A, Nadeau C, Frank S, Alexandre J, Selle F, Berton-Rigaud D, Kalbacher E, Orfeuvre H, Lortholary A, Augereau P, Labombarda F, Perrier L, Grellard JM, Licaj I, Clarisse B, Savoye AM, Bourien H, De La Motte Rouge T, Kurtz JE, Kerdja K, Lelaidier A, Charreton A, Ray-Coquard I, Joly F. "Chronic fatigue, quality of life and long-term side-effects of chemotherapy in patients treated for non-epithelial ovarian cancer: national case-control protocol study of the GINECO-Vivrovaire rare tumors INCa French network for rare malignant ovarian tumors". BMC Cancer 2021; 21:1147. [PMID: 34702204 PMCID: PMC8549373 DOI: 10.1186/s12885-021-08864-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Germ cell tumors and sex cord stromal tumors are rare cancers of the ovary. They mainly affect young women and are associated with a high survival rate. The standard treatment mainly involves conservative surgery combined with chemotherapy [bleomycin, etoposide and cisplatin (BEP)] depending on the stage and the prognostic factors, as for testicular cancers. As reported in testicular cancer survivors, chemotherapy may induce sequelae impacting quality of life, which has not yet been evaluated in survivors of germ cell tumors and sex cord stromal tumors. The GINECO-VIVROVAIRE-Rare tumor study is a two-step investigation aiming to assess i) chronic fatigue and quality of life and ii) long-term side-effects of chemotherapy with a focus on cardiovascular and pulmonary disorders. METHODS Using self-reported questionnaires, chronic fatigue and quality of life are compared between 134 ovarian cancer survivors (cancer-free ≥2 years after treatment) treated with surgery and chemotherapy and 2 control groups (67 ovarian cancer survivors treated with surgery alone and 67 age-matched healthy women). Medical data are collected from patient records. In the second step evaluating the long-term side-effects of chemotherapy, a subgroup of 90 patients treated with chemotherapy and 45 controls undergo the following work-up: cardiovascular evaluation (clinical examination, non-invasive cardiovascular tests to explore heart disease, blood tests), pulmonary function testing, audiogram, metabolic and hormonal blood tests. Costs of sequelae will be also assessed. Patients are selected from the registry of the INCa French Network for Rare Malignant Ovarian Tumors, and healthy women by the 'Seintinelles' connected network (collaborative research platform). DISCUSSION This study will provide important data on the potential long-term physical side-effects of chemotherapy in survivors of Germ Cell Tumors (GCT) and Sex Cord Stromal Tumors (SCST), especially cardiovascular and pulmonary disorders, and neurotoxicity. The identification of long-term side-effects can contribute to adjusting the treatment of ovarian GCT or SCST patients and to managing follow-up with adapted recommendations regarding practices and chemotherapy regimens, in order to reduce toxicity while maintaining efficacy. Based on the results, intervention strategies could be proposed to improve the management of these patients during their treatment and in the long term. TRIAL REGISTRATION This trial was registered at clinicaltrials.gov : 03418844 , on 1 February 2018. This trial was registered on 25 October 2017 under the unique European identification number (ID-RCB): 2017-A03028-45. Recruitment Status: Recruiting. PROTOCOL VERSION Version n° 4.2 dated from Feb 19, 2021. TRIAL SPONSOR Centre François Baclesse, 3 avenue du Général Harris, F-14076 Caen cedex 05, France.
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Affiliation(s)
- François Gernier
- Clinical Research Department, Baclesse Cancer Center, 3 av. general Harris, 14076, Caen, France. .,INSERM, U1086, Caen, France.
| | - Djihane Ahmed-Lecheheb
- Clinical Research Department, Baclesse Cancer Center, 3 av. general Harris, 14076, Caen, France.,INSERM, U1086, Caen, France
| | - Patricia Pautier
- Gustave Roussy Cancer Center, Department of Medical Oncology, Université Paris-Saclay, Villejuif, France
| | | | | | | | | | | | | | | | | | | | - Paule Augereau
- Integrated Center for Oncology Nantes-Angers, Angers, France
| | | | - Lionel Perrier
- University of Lyon, Centre Léon Bérard, GATE L-SE UMR 5824, Lyon, France
| | - Jean-Michel Grellard
- Clinical Research Department, Baclesse Cancer Center, 3 av. general Harris, 14076, Caen, France
| | - Idlir Licaj
- Clinical Research Department, Baclesse Cancer Center, 3 av. general Harris, 14076, Caen, France.,INSERM, U1086, Caen, France
| | - Bénédicte Clarisse
- Clinical Research Department, Baclesse Cancer Center, 3 av. general Harris, 14076, Caen, France
| | | | | | | | | | - Katia Kerdja
- Clinical Research Department, Baclesse Cancer Center, 3 av. general Harris, 14076, Caen, France
| | - Anaïs Lelaidier
- North-West Canceropole Data Center, Baclesse Cancer Center, Caen, France
| | - Amandine Charreton
- Léon Bérard Cancer Center, Université Claude Bernard, laboratoire HESPER, Lyon, France
| | - Isabelle Ray-Coquard
- Léon Bérard Cancer Center, Université Claude Bernard, laboratoire HESPER, Lyon, France
| | - Florence Joly
- Clinical Research Department, Baclesse Cancer Center, 3 av. general Harris, 14076, Caen, France.,INSERM, U1086, Caen, France.,Université de Caen Basse-Normandie, UMR-S1077, Caen, France.,Department of Oncology, CHU de Caen, Caen, France
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10
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Ganguly S, Gargy S, Basu A, Chatterjee M, Ghosh A, Chakraborti B, Biswas B, Dabkara D, Rai S, Roy A, Mathai S, Bhaumik J, Ghosh J. Multidisciplinary management of ovarian germ cell tumours-a single institutional study from India. Ecancermedicalscience 2021; 15:1290. [PMID: 34824613 PMCID: PMC8580601 DOI: 10.3332/ecancer.2021.1290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Ovarian germ cell tumours constitute a heterogeneous group of neoplasm with malignant potential being seen in 5% of cases. There is limited data on treatment outcomes of patients with malignant ovarian germ cell tumours (MOGCT). Here, we present our hospital audit of patients with MOGCT. MATERIAL AND METHODS This is a retrospective data review of patients with MOGCT treated between May 2011 and December 2019. Patients were treated with staging laparotomy and adjuvant chemotherapy, wherever applicable. Surveillance was allowed for those at low risk for recurrence. Clinicopathologic features and treatment details were recorded, and survival analysis was performed. RESULTS Sixty-five patients with a median age of 25 years (range: 11-52 years) were treated during the study period. The most common histology was immature teratoma in 35.3% of cases. International Federation of Gynecology and Obstetrics stage IC was the most common stage of presentation (47%). Surveillance was advised for 12.3% of cases. Systemic therapy was given in 51 (78%) patients. At a median follow-up of 46 months (range: 1-109 months), the median progression-free survival (PFS) was not reached. Five-year PFS was 79.3% (95% CI: 65.8-88). The most common toxicity was febrile neutropenia (22%) among those who received systemic therapy. CONCLUSION Immature teratoma was the most common histology in our series. The majority presented in the early stage. MOGCT is a highly curable disease with surgery and systemic therapy.
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Affiliation(s)
- Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Sumedha Gargy
- Department of Gynaecology, Rajendra Institute of Medical Sciences, Ranchi 834009, India
| | - Archisman Basu
- Department of Medical Oncology, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Meheli Chatterjee
- Department of Medical Oncology, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Anik Ghosh
- Department of Gynaecologic Oncosurgery, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Basumita Chakraborti
- Department of Gynaecologic Oncosurgery, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Shweta Rai
- Department of Gynaecologic Oncosurgery, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Arunava Roy
- Department of Gynaecologic Oncosurgery, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Sonia Mathai
- Department of Gynaecologic Oncosurgery, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Jaydip Bhaumik
- Department of Gynaecologic Oncosurgery, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Joydeep Ghosh
- Department of Medical Oncology, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
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11
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Amiri A, Chovanec M, Oliva V, Sedliak M, Mego M, Ukropec J, Ukropcová B. Chemotherapy-induced toxicity in patients with testicular germ cell tumors: The impact of physical fitness and regular exercise. Andrology 2021; 9:1879-1892. [PMID: 34245663 DOI: 10.1111/andr.13078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/04/2021] [Accepted: 07/07/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Testicular germ cell tumors (TGCTs) represent ∼95% of testicular malignancies and are the most common type of malignancy in young male adults. While the incidence of TGCTs has increased during the last decades, the advances in treatment, namely introducing cisplatin into the chemotherapy regimen, have made TGCTs highly curable with the 10-year survival rate exceeding 95%. However, in parallel with increased cure rates, survivors may experience acute and late adverse effects of treatment, which increase morbidity, reduce the quality of life, and can be potentially life-threatening. Chemotherapy-related toxicities include cardiovascular and metabolic diseases, secondary cancer, avascular necrosis, cognitive impairment, cancer-related fatigue, poor mental health-related quality of life, nephrotoxicity, hypogonadism, neurotoxicity, pulmonary toxicity, anxiety, and depression. These treatment-related adverse effects have emerged as important survivorship dilemmas in TGCT cancer survivors. Recently, regular physical exercise has increasingly attracted research and clinical attention as an adjunct therapy for cancer patients. PURPOSE Herein, we review the most common chemotherapy-related adverse effects in TGCT survivors and clinical relevance of exercise and increased cardio-respiratory fitness in modulating chemotherapy-related toxicity and quality of life in this population. RESULTS AND CONCLUSION Exercise has positive effects on a spectrum of physical and psychosocial outcomes during and after cancer treatment, and current guidelines on exercise prescription in chronic diseases define the recommended dose (volume and intensity) of regular exercise for cancer survivors, highlighting regular, sufficiently intensive physical activity as an essential part of patients' care.
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Affiliation(s)
- Ali Amiri
- Department of Metabolic Disease Research & Center of Physical Activity Research, Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Michal Chovanec
- 2nd, Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Viktor Oliva
- Faculty of Physical Education and Sports, Comenius University, Bratislava, Slovakia
| | - Milan Sedliak
- Faculty of Physical Education and Sports, Comenius University, Bratislava, Slovakia
| | - Michal Mego
- 2nd, Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Jozef Ukropec
- Department of Metabolic Disease Research & Center of Physical Activity Research, Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Barbara Ukropcová
- Department of Metabolic Disease Research & Center of Physical Activity Research, Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia.,Institute of Pathophysiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
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12
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Zraik IM, Heß-Busch Y. [Management of chemotherapy side effects and their long-term sequelae]. Urologe A 2021; 60:862-871. [PMID: 34185118 DOI: 10.1007/s00120-021-01569-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 11/28/2022]
Abstract
Various chemotherapies are used to treat testicular cancer. The most common therapy regimens are BEP (cisplatin, etoposide, bleomycin), carboplatin mono (AUC 7), PEI (cisplatin, etoposide, ifosfamide), TIP (cisplatin, ifosfamide, paclitaxel) and GOP (gemcitabine, oxaliplatin, paclitaxel). This is accompanied by acute and late toxicities. These include general side effects such as anemia, neutropenia, nausea, vomiting, diarrhea, mucositis or paravasation as well as special toxicities like ototoxicity, nephrotoxicity, pulmonary toxicity, neurotoxicity or Raynaud's syndrome. Since young men are usually affected, the possible long-term consequences such as hypogonadism, infertility or the metabolic syndrome are very relevant. Accordingly, adequate management of the possible side effects and long-term consequences in the context of the use of chemotherapy is essential.
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Affiliation(s)
- Isabella M Zraik
- Klinik für Urologie, Kinderurologie & Urologische Onkologie, Evang. Kliniken Essen-Mitte, Henricistr. 92, 45136, Essen, Deutschland.
| | - Yasmine Heß-Busch
- Klinik für Internistische Onkologie & Hämatologie mit integrierter Palliativmedizin, Evang. Kliniken Essen-Mitte, Henricistr. 92, 45136, Essen, Deutschland.
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13
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Chovanec M, Lauritsen J, Bandak M, Oing C, Kier GG, Kreiberg M, Rosenvilde J, Wagner T, Bokemeyer C, Daugaard G. Late adverse effects and quality of life in survivors of testicular germ cell tumour. Nat Rev Urol 2021; 18:227-245. [PMID: 33686290 DOI: 10.1038/s41585-021-00440-w] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 02/06/2023]
Abstract
Currently, ~95% of patients with testicular germ cell tumour (TGCT) are cured, resulting in an increasing number of TGCT survivors. Although cured, these men face potential late adverse effects and reduced quality of life. Survivors face a twofold increased risk of second malignant neoplasms after chemotherapy and radiotherapy, with evidence of dose-dependent associations. For survivors managed with surveillance or treated with radiotherapy, the risk of cardiovascular disease (CVD) is comparable to the risk in the general population, whereas treatment with chemotherapy increases the risk of life-threatening CVD, especially during treatment and after 10 years of follow-up. Other adverse effects are organ-related toxicities such as neuropathy and ototoxicity. Pulmonary and renal impairment in patients with TGCT treated with chemotherapy is limited. Survivors of TGCT might experience psychosocial distress including anxiety disorders, fear of cancer recurrence and TGCT-specific issues, such as sexual dysfunction. Late adverse effects can be avoided in most patients with stage I disease if followed on a surveillance programme. However, patients with disseminated disease can experience toxicities associated with radiotherapy and chemotherapy, and/or adverse effects related to surgery for residual disease. The severity of adverse effects increases with dose of both chemotherapy and radiotherapy. This Review discusses the most recent data concerning the late adverse effects of today's standard treatments for TGCT.
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Affiliation(s)
- Michal Chovanec
- 2nd Department of Oncology, Comenius University, National Cancer Institute, Bratislava, Slovakia
| | - Jakob Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Bandak
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christoph Oing
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gry Gundgaard Kier
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Michael Kreiberg
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Josephine Rosenvilde
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Wagner
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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14
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Lavi A, Clark R, Ly TL, Nair SM, Hetou K, Haan M, Power NE. Long-term Testis Cancer Survivors in Canada-Mortality Risks in a Large Population-based Cohort. EUR UROL SUPPL 2020; 22:54-60. [PMID: 34337478 PMCID: PMC8317812 DOI: 10.1016/j.euros.2020.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Testis cancer (TC) patients are young with excellent cancer prognosis. Hence, the risk of late-onset treatment-related morbidity and mortality is of concern due to longer survival after treatment. OBJECTIVE We set to characterize long-term survival of TC patients through a Canadian population dataset. DESIGN SETTING AND PARTICIPANTS We used a population-based dataset, the Canadian Census Health and Environment Cohort (CanCHEC), to identify individuals diagnosed with TC between 1991 and 2010. We compared them with all other male individuals without TC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was mortality due to cardiovascular disease (CVD) or nontesticular malignancy. Mann-Whitney or chi-square test was used where applicable. Data were analyzed using a Cox proportional hazard model with and without matching. RESULTS AND LIMITATIONS We identified 1950 individuals with TC. We compared them with 1 300 295 men with no TC. There were 335 deaths in the study group during the study period (17.2%) with a mean follow-up of 19.6 yr. TC patients were at increased risk of death from secondary malignancies (hazard ratio [HR] 1.63, 95% confidence interval [CI] 1.39-1.91; p < 0.0001) with specific risks for hematologic neoplasms (HR 3.86, 95% CI 2.78-5.37; p < 0.001) and other malignancies (HR 2.41, 95% CI 1.76-3.29; p < 0.001). Gastrointestinal, hematologic, and respiratory toxicities were the most common secondary malignancies leading to death. When stratified according to histology, nonseminoma (NS) patients were at significantly increased risk of death from CVD (HR 2.03, 95% CI 1.27-3.25; p = 0.0032). Individuals with seminoma were at increased risk of death from other nontestis neoplasms (HR 1.46, 95% CI 1.17-1.82; p = 0.0007), specifically hematologic neoplasms (HR 2.09, 95% CI 1.18-3.72; p = 0.0118). CONCLUSIONS NS patients are at increased risk of CVD-related death, whereas seminoma patients are at increased risk of death from non-testis-related malignancies. PATIENT SUMMARY We report long-term mortality following diagnosis of testis cancer. Nonseminoma patients have an increased risk of death from cardiovascular disease, while seminoma patients have an increased risk of death from secondary malignancies.
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Affiliation(s)
- Arnon Lavi
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Roderick Clark
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Tina Luu Ly
- Department of Sociology, Western University, London, Ontario, Canada
| | - Shiva M. Nair
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Khalil Hetou
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Michael Haan
- Department of Sociology, Western University, London, Ontario, Canada
| | - Nicholas E. Power
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
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15
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Xu P, Choi E, White K, Yafi FA. Low Testosterone in Male Cancer Patients and Survivors. Sex Med Rev 2020; 9:133-142. [PMID: 32430241 DOI: 10.1016/j.sxmr.2020.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Hypogonadism (HG) is prevalent among patients with ongoing advanced cancer and cancer survivors. The etiology of HG in these patients is multifactorial and can be examined from cancer-related and cancer-treatment perspectives. There is evidence that HG contributes to increased morbidity in male cancer patients. Testosterone replacement therapy (TRT) for cancer survivors and advanced cancer patients is not well studied outside of prostate cancer. Here, we evaluate and summarize the current literature on HG in male cancer patients, including the role of TRT in nonprostate cancer patients. OBJECTIVE To summarize and present the literature for the background, etiology, clinical consequences, and treatment for HG in male cancer patients and survivors. METHODS A literature review was performed in MEDLINE between 1980 and 2020 using the terms hypogonadism, advanced cancer, testosterone replacement therapy, quality of life, and cancer survivors. Studies including only prostate cancer patients were excluded. RESULTS The main outcome measure was to complete a review of peer-reviewed literature. HG is not only prevalent among male cancer patients and survivors but also clinically reduces quality of life and increases morbidity. The etiology of HG in male cancer patients and survivors is multifactorial. There are few studies examining the benefit of TRT in these patient populations. The results of randomized controlled trials show potential benefit for TRT in hypogonadal male cancer survivors and those with advanced cancer. CONCLUSION HG affects many male cancer patients and survivors because of a multifactorial etiology. HG in these patients contributes to increased morbidity and reduced quality of life. Treatment of HG in male cancer patients is not well studied, and further studies are needed to elucidate the role of TRT. Xu P, Choi E, White K, et al. Low Testosterone in Male Cancer Patients and Survivors. Sex Med 2021;9:133-142.
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Affiliation(s)
- Perry Xu
- Department of Urology, University of California Irvine, Irvine, CA, USA
| | - Edward Choi
- Department of Urology, University of California Irvine, Irvine, CA, USA
| | - Kayla White
- Department of Urology, University of California Irvine, Irvine, CA, USA
| | - Faysal A Yafi
- Department of Urology, University of California Irvine, Irvine, CA, USA.
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16
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Zhang J, Guo Y, Pan G, Wang P, Li Y, Zhu X, Zhang C. Injectable Drug-Conjugated DNA Hydrogel for Local Chemotherapy to Prevent Tumor Recurrence. ACS APPLIED MATERIALS & INTERFACES 2020; 12:21441-21449. [PMID: 32314901 DOI: 10.1021/acsami.0c03360] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Considering the high rate of postsurgical tumor recurrence due to the possible residual cancer cells and the non-negligible toxicity of postsurgical systemic chemotherapy, we designed an injectable DNA hydrogel assembled by chemodrug-grafted DNA strands for localized chemotherapy. First, a multitude of camptothecin was successfully grafted on backbones of the phosphorothioate DNAs, which could be assembled into two types of Y-shaped building blocks and then hierarchically associated together to form drug-containing hydrogels. The injectable feature of drug-containing DNA hydrogels enables a minimally invasive approach for local drug administration. Owing to the enzymatic degradation, the hydrogel can gradually disassemble into nanosized particles, allowing its good permeation into the residual tumor tissue and efficient uptake by cells. Together with its sustained and responsive drug release behaviors, the drug-containing DNA hydrogel can significantly inhibit the regrowth of tumor cells and prevent cancer recurrence. Compared to the control groups, mice treated with our drug-containing DNA hydrogel show the lowest tumor relapse rate (1/3) and substantial slow tumor progression. Despite the long-term local embedding, negligible systemic toxicity and organ damages are observed after the treatment with our drug-grafted DNA hydrogel. With excellent antitumor efficacy and low side effects in vivo, our DNA-drug conjugate (DDC)-based hydrogel represents a promising candidate for local adjuvant therapy in cancer treatment.
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Affiliation(s)
- Jiao Zhang
- School of Chemistry and Chemical Engineering, Frontiers Science Center for Transformative Molecules, State Key Laboratory of Metal Matrix Composites, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yuanyuan Guo
- School of Chemistry and Chemical Engineering, Frontiers Science Center for Transformative Molecules, State Key Laboratory of Metal Matrix Composites, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Gaifang Pan
- School of Chemistry and Chemical Engineering, Frontiers Science Center for Transformative Molecules, State Key Laboratory of Metal Matrix Composites, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Ping Wang
- Weigao Research Center, 304, Building 2, Lane 720, Cailun Road, Shanghai 201203, China
| | - Yuehua Li
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yi Shan Road, Shanghai 200233, China
| | - Xinyuan Zhu
- School of Chemistry and Chemical Engineering, Frontiers Science Center for Transformative Molecules, State Key Laboratory of Metal Matrix Composites, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Chuan Zhang
- School of Chemistry and Chemical Engineering, Frontiers Science Center for Transformative Molecules, State Key Laboratory of Metal Matrix Composites, Shanghai Jiao Tong University, Shanghai 200240, China
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17
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Lubberts S, Meijer C, Demaria M, Gietema JA. Early ageing after cytotoxic treatment for testicular cancer and cellular senescence: Time to act. Crit Rev Oncol Hematol 2020; 151:102963. [PMID: 32446180 DOI: 10.1016/j.critrevonc.2020.102963] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 12/15/2022] Open
Abstract
Treatment of testicular cancer (TC) has an exceptionally high success rate compared to other cancer types; even in case of metastasized disease, 80-90 % of TC patients can be cured. Consequently, attention has been drawn to a potential downside of this treatment success: late adverse treatment effects such as the accelerated development of otherwise age-associated features like cardiovascular disease and second malignancies. Underlying mechanisms are poorly understood. Emerging data suggest that cytotoxic treatment induces cellular senescence, resulting in secretion of inflammatory factors contributing to this early ageing phenotype. Molecular and cellular characterization of this early ageing will enhance understanding the pathogenesis of TC treatment-induced morbidity and contribute to better recognition and prevention of late effects. In this review, we describe clinical manifestations of the early ageing phenotype among TC survivors, and subsequently focus on potential underlying mechanisms. We discuss the clinical implications and describe perspectives for future research and intervention strategies.
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Affiliation(s)
- Sjoukje Lubberts
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Coby Meijer
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Marco Demaria
- European Institute for the Biology of Ageing (ERIBA), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Jourik A Gietema
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, The Netherlands.
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18
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Espíldora-Hernández J, Díaz-Antonio T, Baena-Espinar J, Alonso-Calderón I, Rioja J, Alba-Conejo E, Valdivielso P, Sánchez-Chaparro MÁ. Subclinical Arteriosclerosis is Associated With Common Vascular Risk Factors in Long-Term Survivors of Testicular Cancer. J Clin Med 2020; 9:E971. [PMID: 32244483 PMCID: PMC7231146 DOI: 10.3390/jcm9040971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 12/02/2022] Open
Abstract
Cardiovascular disease risk is increased in survivors of testicular cancer because of exposure to treatment (chemotherapy and radiotherapy), as well as modification in lifestyle. Our aim was to assess the presence of subclinical arteriosclerosis in survivors of testicular cancer in comparison with a control group. This was a cross-sectional, observational, case-control study including 50 survivors of Germ Cell Tumor (GCT) (14 years of follow-up) and 53 age-matched controls with no cancer. We registered clinical data, cardiovascular risk factors, physical and Mediterranean questionnaires, intima-media thickness and plaque at carotid and femoral arteries by ultrasound, calcium score at the abdominal aorta, and liver steatosis by computed tomography, and applied analytical tests to quantify metabolic risk factors and inflammation markers. Patients showed a trend toward greater intima-media thickness (IMT) and plaques than controls, as well as a higher calcium score in the abdominal aorta. Remarkably, patients had higher waist circumference, insulin resistance (HOMA-IR), and liver steatosis, but lower physical activity and high-density lipoprotein (HDL) cholesterol than controls (all p < 0.05). In multivariate analyses, only common vascular risk factors were associated with subclinical arteriosclerosis. As a conclusion, in our study, a higher rate of subclinical arteriosclerosis in testicular cancer survivors was associated with classical metabolic risk factors and lifestyle, but not with exposure to chemotherapy.
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Affiliation(s)
| | | | - Javier Baena-Espinar
- Oncology Unit, Hospital Virgen de la Victoria, 29010 Málaga, Spain; (J.B.-E.); (E.A.-C.)
| | | | - José Rioja
- Lipid and Arteriosclerosis Laboratory, Department of Medicine and Dermatology, and Biomedical Institute for Research (IBIMA), Universidad de Málaga, 29010 Málaga, Spain;
| | - Emilio Alba-Conejo
- Oncology Unit, Hospital Virgen de la Victoria, 29010 Málaga, Spain; (J.B.-E.); (E.A.-C.)
| | - Pedro Valdivielso
- Internal Medicine Unit, Hospital Virgen de la Victoria, 29010 Málaga, Spain; (J.E.-H.); (M.-Á.S.-C.)
- Lipid and Arteriosclerosis Laboratory, Department of Medicine and Dermatology, and Biomedical Institute for Research (IBIMA), Universidad de Málaga, 29010 Málaga, Spain;
| | - Miguel-Ángel Sánchez-Chaparro
- Internal Medicine Unit, Hospital Virgen de la Victoria, 29010 Málaga, Spain; (J.E.-H.); (M.-Á.S.-C.)
- Lipid and Arteriosclerosis Laboratory, Department of Medicine and Dermatology, and Biomedical Institute for Research (IBIMA), Universidad de Málaga, 29010 Málaga, Spain;
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19
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Nowakowska M, Płońska-Gościniak E, Szyszka A, Chrzanowski Ł, Krakowska M, Potemski P, Mizia-Stec K, Gąsior Z, Bodys A, Siński M, Gościńska-Szmagała A, Gościniak P, Różewicz M, Zaborska B, Braksator W, Kosior D, Kasprzak JD. Cardiovascular risk factors among cancer patients qualified for systemic treatment. Analysis of a cardiovascular disease-free cohort from the Polish multicentre study ONCOECHO. Arch Med Sci 2020; 16:1295-1303. [PMID: 33224328 PMCID: PMC7667439 DOI: 10.5114/aoms.2020.100401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 04/15/2018] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Cancer therapies are currently more efficient at increasing the survival of patients (pts) with cancer. Unfortunately, the cardiovascular (CV) complications of cancer therapies may adversely affect improving results of treatment. The aim of the study was to evaluate the prevalence of classical CV risk factors among pts with de novo diagnosis of cancer and thus identify the cohort of pts with potentially increased future risk of CV complications. MATERIAL AND METHODS The analysis is based on the database of the multicentre ONCOECHO study. Pts before systemic treatment (chemotherapy or targeted therapy) were included. The diagnostic datasets of resting electrocardiogram, blood samples, and transthoracic echocardiogram were analysed in 343 consecutive pts who were free from any cardiovascular disease that could adversely affect the introduced treatment. RESULTS Our cohort included 4.4% of pts with kidney cancer, 7.3% with colorectal cancer, 26.5% with haematological malignancies (HM), and 61.8% with breast cancer. The risk estimated by SCORE was 4.56 ±5.07%. Breast cancer pts had lower cardiovascular risk than those with HM (p = 0.001) and kidney cancer (p = 0.002). Additionally, the HM group had much higher levels of natriuretic peptides (p < 0.001) and creatinine (p = 0.008) than pts with breast cancer. The comparison with the NATPOL population data showed that our pts were more often smokers, hypertensives, and diabetics, but less frequently presented with hypercholesterolaemia. CONCLUSIONS Patients with new diagnosis of cancer, who are candidates for potentially cardiotoxic medical treatment, have increased prevalence of significant cardiovascular risk factors and therefore should be followed by a multidisciplinary team during the therapeutic process.
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Affiliation(s)
- Marta Nowakowska
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | | | - Andrzej Szyszka
- Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Magdalena Krakowska
- Chemotherapy Clinic, Oncology Department, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | - Piotr Potemski
- Chemotherapy Clinic, Oncology Department, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | | | - Zbigniew Gąsior
- Department of Cardiology, Silesian Medical University, Katowice, Poland
| | - Artur Bodys
- Department of Cardiology, Stefan Cardinal Wyszynski Regional Hospital, Lublin, Poland
| | - Maciej Siński
- Department of Internal Medicine, Hypertension and Angiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Piotr Gościniak
- Independent Laboratory of Non-Invasive Heart Diagnostics for Children and Adults, Independent Public Clinical Hospital No. 1, Pomeranian Medical University, Szczecin, Poland
| | - Monika Różewicz
- Department of Congenital Cardiac Defects, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland
| | - Beata Zaborska
- Department of Cardiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Wojciech Braksator
- Department of Sports Cardiology and Noninvasive Cardiac Diagnosis, Medical University of Warsaw, Warsaw, Poland
| | - Dariusz Kosior
- Department of Cardiology and Hypertension, Central Clinical Hospital of Ministry of the Interior and Administration, Warsaw, Poland
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20
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Bucher-Johannessen C, Page CM, Haugen TB, Wojewodzic MW, Fosså SD, Grotmol T, Haugnes HS, Rounge TB. Cisplatin treatment of testicular cancer patients introduces long-term changes in the epigenome. Clin Epigenetics 2019; 11:179. [PMID: 31796056 PMCID: PMC6892132 DOI: 10.1186/s13148-019-0764-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 10/15/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Cisplatin-based chemotherapy (CBCT) is part of standard treatment of several cancers. In testicular cancer (TC) survivors, an increased risk of developing metabolic syndrome (MetS) is observed. In this epigenome-wide association study, we investigated if CBCT relates to epigenetic changes (DNA methylation) and if epigenetic changes render individuals susceptible for developing MetS later in life. We analyzed methylation profiles, using the MethylationEPIC BeadChip, in samples collected ~ 16 years after treatment from 279 Norwegian TC survivors with known MetS status. Among the CBCT treated (n = 176) and non-treated (n = 103), 61 and 34 developed MetS, respectively. We used two linear regression models to identify if (i) CBCT results in epigenetic changes and (ii) epigenetic changes play a role in development of MetS. Then we investigated if these changes in (i) and (ii) links to genes, functional networks, and pathways related to MetS symptoms. RESULTS We identified 35 sites that were differentially methylated when comparing CBCT treated and untreated TC survivors. The PTK6-RAS-MAPk pathway was significantly enriched with these sites and infers a gene network of 13 genes with CACNA1D (involved in insulin release) as a network hub. We found nominal MetS-associations and a functional gene network with ABCG1 and NCF2 as network hubs. CONCLUSION Our results suggest that CBCT has long-term effects on the epigenome. We could not directly link the CBCT effects to the risk of developing MetS. Nevertheless, since we identified differential methylation occurring in genes associated with conditions pertaining to MetS, we hypothesize that epigenomic changes may also play a role in the development of MetS in TC survivors. Further studies are needed to validate this hypothesis.
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Affiliation(s)
| | - Christian M Page
- Oslo Centre for Biostatistics and Epidemiology, Section for Research Support, Oslo University Hospital, Oslo, Norway.,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Trine B Haugen
- Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | | | - Sophie D Fosså
- Department of Research, Cancer Registry of Norway, Oslo, Norway.,Department of Oncology, The Norwegian Radium Hospital/Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tom Grotmol
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Hege S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway.,Institute of Clinical Medicine, UIT The Arctic University of Norway, Tromsø, Norway
| | - Trine B Rounge
- Department of Research, Cancer Registry of Norway, Oslo, Norway. .,Department of Informatics, University of Oslo, Oslo, Norway.
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21
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de Fine Licht S, Maraldo MV, Specht L, Nielsen TT, Winther JF, Rugbjerg K. Risk factors for cardiovascular disease in 5-year survivors of adolescent and young adult cancer: A Danish population-based cohort study. Cancer 2019; 126:659-669. [PMID: 31714589 DOI: 10.1002/cncr.32580] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/04/2019] [Accepted: 09/04/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND An increased risk of metabolic syndrome has been reported for childhood cancer survivors and for adult survivors with certain cancer types. One previous study reported on the risk for diseases in the metabolic syndrome specifically among survivors of adolescent and young adult cancers. METHODS The study comprised 11,822 five-year survivors of adolescent and young adult cancer (ages 15-39 years at diagnosis) who were diagnosed during the period from 1994 through 2009 in Denmark and a population-based comparison cohort of 76,024 individuals. The cohorts were linked to Danish nationwide registries for information on hospital contacts and purchase of prescription drugs related to metabolic syndrome, respectively. Standardized rate ratios (RRs) for hospital contacts (SHRRs) and prescriptions (SPRRs) with 95% CIs were calculated for diabetes, hyperlipidemia, and hypertension. RESULTS Survivors had increased risks for hospital contacts and prescriptions for diabetes (SHRR, 1.21; 95% CI, 1.03-1.43; SPRR, 1.08; 95% CI, 0.96-1.23), hyperlipidemia (SHRR, 1.18; 95% CI, 1.00-1.40; SPRR, 1.16; 95% CI, 1.08-1.25), and hypertension (SHRR, 1.27; 95% CI, 1.15-1.41; SPRR, 1.25; 95% CI, 1.20-1.31). The highest risks for hospitalizations were among survivors of brain cancer (RR, 2.94 for diabetes) and Hodgkin lymphoma (RR, 2.40 for diabetes). Survivors of brain cancer and Hodgkin lymphoma were most likely to purchase prescription drugs for diseases in metabolic syndrome. CONCLUSIONS Survivors of adolescent and young adult cancer are at increased risk of hospital contacts and purchase of prescription drugs for diseases in metabolic syndrome. Survivors at high risk should be followed closely to improve prevention, early detection, and management of these diseases to ultimately minimize the risk of cardiovascular diseases.
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Affiliation(s)
- Sofie de Fine Licht
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Maja V Maraldo
- Department of Clinical Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lena Specht
- Department of Clinical Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas T Nielsen
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Kathrine Rugbjerg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
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22
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Imaging of Metastatic Germ Cell Tumors in Male Patients From Initial Diagnosis to Treatment-Related Toxicities: A Primer for Radiologists. AJR Am J Roentgenol 2019; 214:24-33. [PMID: 31573853 DOI: 10.2214/ajr.19.21623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. This review describes the influence of histology and metastatic sites on prognosis in male patients with metastatic germ cell tumors (GCTs) and explains the role imaging in assessing therapeutic response, residual disease, recurrence, sand treatment-related toxicities. CONCLUSION. Seminomatous and nonseminomatous GCTs differ in imaging appearance, pattern of spread, and prognosis, and an organ-based approach is helpful in prognostication. Multimodality imaging aids in accurate staging, prognostication, characterization of treatment response, and identification of therapy-related toxicity.
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23
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Zaid MA, Gathirua-Mwangi WG, Fung C, Monahan PO, El-Charif O, Williams AM, Feldman DR, Hamilton RJ, Vaughn DJ, Beard CJ, Cook R, Althouse SK, Ardeshir-Rouhani-Fard S, Dinh PC, Sesso HD, Einhorn LH, Fossa SD, Travis LB. Clinical and Genetic Risk Factors for Adverse Metabolic Outcomes in North American Testicular Cancer Survivors. J Natl Compr Canc Netw 2019. [PMID: 29523664 DOI: 10.6004/jnccn.2017.7046] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: Testicular cancer survivors (TCS) are at significantly increased risk for cardiovascular disease (CVD), with metabolic syndrome (MetS) an established risk factor. No study has addressed clinical and genetic MetS risk factors in North American TCS. Patients and Methods: TCS were aged <55 years at diagnosis and received first-line chemotherapy. Patients underwent physical examination, and had lipid panels, testosterone, and soluble cell adhesion molecule-1 (sICAM-1) evaluated. A single nucleotide polymorphism in rs523349 (5-α-reductase gene, SRD5A2), recently implicated in MetS risk, was genotyped. Using standard criteria, MetS was defined as ≥3 of the following: hypertension, abdominal obesity, hypertriglyceridemia, decreased high-density lipoprotein (HDL) cholesterol level, and diabetes. Matched controls were derived from the National Health and Nutrition Examination Survey. Results: We evaluated 486 TCS (median age, 38.1 years). TCS had a higher prevalence of hypertension versus controls (43.2% vs 30.7%; P<.001) but were less likely to have decreased HDL levels (23.7% vs 34.8%; P<.001) or abdominal obesity (28.2% vs 40.1%; P<.001). Overall MetS frequency was similar in TCS and controls (21.0% vs 22.4%; P=.59), did not differ by treatment (P=.20), and was not related to rs523349 (P=.61). For other CVD risk factors, TCS were significantly more likely to have elevated low-density lipoprotein (LDL) cholesterol levels (17.7% vs 9.3%; P<.001), total cholesterol levels (26.3% vs 11.1%; P<.001), and body mass index ≥25 kg/m2 (75.1% vs 69.1%; P=.04). On multivariate analysis, age at evaluation (P<.001), testosterone level ≤3.0 ng/mL (odds ratio [OR], 2.06; P=.005), and elevated sICAM-1 level (ORhighest vs lowest quartile, 3.58; P=.001) were significantly associated with MetS. Conclusions and Recommendations: Metabolic abnormalities in TCS are characterized by hypertension and increased LDL and total cholesterol levels but lower rates of decreased HDL levels and abdominal obesity, signifying possible shifts in fat distribution and fat metabolism. These changes are accompanied by hypogonadism and inflammation. TCS have a high prevalence of CVD risk factors that may not be entirely captured by standard MetS criteria. Cancer treatment-associated MetS requires further characterization.
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24
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Miller KD, Nogueira L, Mariotto AB, Rowland JH, Yabroff KR, Alfano CM, Jemal A, Kramer JL, Siegel RL. Cancer treatment and survivorship statistics, 2019. CA Cancer J Clin 2019; 69:363-385. [PMID: 31184787 DOI: 10.3322/caac.21565] [Citation(s) in RCA: 2858] [Impact Index Per Article: 571.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The number of cancer survivors continues to increase in the United States because of the growth and aging of the population as well as advances in early detection and treatment. To assist the public health community in better serving these individuals, the American Cancer Society and the National Cancer Institute collaborate every 3 years to estimate cancer prevalence in the United States using incidence and survival data from the Surveillance, Epidemiology, and End Results cancer registries; vital statistics from the Centers for Disease Control and Prevention's National Center for Health Statistics; and population projections from the US Census Bureau. Current treatment patterns based on information in the National Cancer Data Base are presented for the most prevalent cancer types. Cancer-related and treatment-related short-term, long-term, and late health effects are also briefly described. More than 16.9 million Americans (8.1 million males and 8.8 million females) with a history of cancer were alive on January 1, 2019; this number is projected to reach more than 22.1 million by January 1, 2030 based on the growth and aging of the population alone. The 3 most prevalent cancers in 2019 are prostate (3,650,030), colon and rectum (776,120), and melanoma of the skin (684,470) among males, and breast (3,861,520), uterine corpus (807,860), and colon and rectum (768,650) among females. More than one-half (56%) of survivors were diagnosed within the past 10 years, and almost two-thirds (64%) are aged 65 years or older. People with a history of cancer have unique medical and psychosocial needs that require proactive assessment and management by follow-up care providers. Although there are growing numbers of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care.
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Affiliation(s)
| | - Leticia Nogueira
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Angela B Mariotto
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | | | - K Robin Yabroff
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | | | - Ahmedin Jemal
- Surveillance Research, American Cancer Society, Atlanta, Georgia
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Joan L Kramer
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance Research, American Cancer Society, Atlanta, Georgia
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25
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Joly F, Ahmed-Lecheheb D, Thiery-Vuillemin A, Orillard E, Coquan E. [Side effects of chemotherapy for testicular cancers and post-cancer follow-up]. Bull Cancer 2019; 106:805-811. [PMID: 31171345 DOI: 10.1016/j.bulcan.2019.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 01/30/2023]
Abstract
Testicular cancers are the most frequent and the most curable cancers in young men. Treatments of these cancers represent a great success with cure rate over to 95 %. However, chemotherapy side effects may occur during or after several years post-treatment. This review aimed to highlight complications and physical and psychological side effects occurring mainly after chemotherapy treatment for testicular cancer, and to propose a personalized post-cancer plan specific for patients treated for testicular cancer. Treatments of these cancers can cause short-term complications (asthenia, nausea, vomiting, alopecia..). These side effects disappear within a few months after the end of the treatments. Late complications may occur several years post-treatment. Cardiovascular disease, metabolic syndrome and secondary neoplasia represent the most severe late effects among patients treated for testicular cancer. Given the increased incidence of these chemotherapy-induced side effects, it is indispensable to establish a specific follow up which must include a particular vigilance on the risk of occurrence of second cancer, a follow-up of the cardio-vascular risk factors, pulmonary and auditory follow-up, and early detection of psychosocial disorders.
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Affiliation(s)
- Florence Joly
- UNICANCER, Centre François Baclesse, Clinical Research Department and Medical Department, avenue général Harris, 14076 Caen, France; Inserm, U1086, 14076 Caen, France; Université de Caen Basse-Normandie, UMR-S1077, 14000 Caen, France; CHU de Caen, Department of Oncology, 14000 Caen, France.
| | - Djihane Ahmed-Lecheheb
- UNICANCER, Centre François Baclesse, Clinical Research Department and Medical Department, avenue général Harris, 14076 Caen, France; Inserm, U1086, 14076 Caen, France
| | | | - Emeline Orillard
- CHU Jean-Minjoz, Département Oncologie médicale, Boulevard Fleming, 25030 Besançon, France
| | - Elodie Coquan
- UNICANCER, Centre François Baclesse, Clinical Research Department and Medical Department, avenue général Harris, 14076 Caen, France
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26
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La Vignera S, Cannarella R, Duca Y, Barbagallo F, Burgio G, Compagnone M, Di Cataldo A, Calogero AE, Condorelli RA. Hypogonadism and Sexual Dysfunction in Testicular Tumor Survivors: A Systematic Review. Front Endocrinol (Lausanne) 2019; 10:264. [PMID: 31133982 PMCID: PMC6513875 DOI: 10.3389/fendo.2019.00264] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/09/2019] [Indexed: 11/13/2022] Open
Abstract
Testicular tumor is the most common malignancy in men of reproductive age. According to the tumor histology and staging, current treatment options include orchiectomy alone or associated with adjuvant chemo- and/or radiotherapy. Although these treatments have considerably raised the percentage of survivors compared to the past, they have been identified as risk factors for testosterone deficiency and sexual dysfunction in this subgroup of men. Male hypogonadism, in turn, predisposes to the development of metabolic and cardiovascular impairment that negatively affects general health. Accordingly, longitudinal studies report a long-term risk for cardiovascular diseases after radiotherapy and/or cisplatin-based chemotherapy in testicular tumor survivors. The aim of this review was to summarize the current evidence on hypogonadism and sexual dysfunction in long-term cancer survivors, including the epidemiology of cardiovascular and metabolic disorders, to increase the awareness that serum testosterone levels, sexual function, and general health should be evaluated during the endocrinological management of these patients.
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Affiliation(s)
- Sandro La Vignera
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rossella Cannarella
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Ylenia Duca
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Federica Barbagallo
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giovanni Burgio
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Michele Compagnone
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Andrea Di Cataldo
- Unit of Pediatric Hematology and Oncology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Aldo E. Calogero
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rosita A. Condorelli
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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27
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Abu Zaid M, Dinh PC, Monahan PO, Fung C, El-Charif O, Feldman DR, Hamilton RJ, Vaughn DJ, Beard CJ, Cook R, Althouse S, Ardeshir-Rouhani-Fard S, Sesso HD, Huddart R, Mushiroda T, Kubo M, Eileen Dolan M, Einhorn LH, Fossa SD, Travis LB. Adverse Health Outcomes in Relationship to Hypogonadism After Chemotherapy: A Multicenter Study of Testicular Cancer Survivors. J Natl Compr Canc Netw 2019; 17:459-468. [PMID: 31085753 PMCID: PMC6712564 DOI: 10.6004/jnccn.2018.7109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/21/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study examined the prevalence of hypogonadism, its clinical and genetic risk factors, and its relationship to adverse health outcomes (AHOs) in North American testicular cancer survivors (TCS) after modern platinum-based chemotherapy. PATIENTS AND METHODS Eligible TCS were <55 years of age at diagnosis and treated with first-line platinum-based chemotherapy. Participants underwent physical examinations and completed questionnaires regarding 15 AHOs and health behaviors. Hypogonadism was defined as serum testosterone levels ≤3.0 ng/mL or use of testosterone replacement therapy. We investigated the role of 2 single nucleotide polymorphisms (rs6258 and rs12150660) in the sex hormone-binding globulin (SHBG) locus implicated in increased hypogonadism risk in the general population. RESULTS Of 491 TCS (median age at assessment, 38.2 years; range, 18.7-68.4 years), 38.5% had hypogonadism. Multivariable binary logistic regression analysis identified hypogonadism risk factors, including age at clinical evaluation (odds ratio [OR], 1.42 per 10-year increase; P= .006) and body mass index of 25 to <30 kg/m2 (OR, 2.08; P= .011) or ≥30 kg/m2 (OR, 2.36; P= .005) compared with <25 kg/m2. TCS with ≥2 risk alleles for the SHBG SNPs had a marginally significant increased hypogonadism risk (OR, 1.45; P= .09). Vigorous-intensity physical activity appeared protective (OR, 0.66; P= .07). Type of cisplatin-based chemotherapy regimen and socioeconomic factors did not correlate with hypogonadism. Compared with TCS without hypogonadism, those with hypogonadism were more likely to report ≥2 AHOs (65% vs 51%; P= .003), to take medications for hypercholesterolemia (20.1% vs 6.0%; P<.001) or hypertension (18.5% vs 10.6%; P= .013), and to report erectile dysfunction (19.6% vs 11.9%; P= .018) or peripheral neuropathy (30.7% vs 22.5%; P= .041). A marginally significant trend for increased use of prescription medications for either diabetes (5.8% vs 2.6%; P= .07) or anxiety/depression (14.8% vs 9.3%; P= .06) was observed. CONCLUSIONS At a relatively young median age, more than one-third of TCS have hypogonadism, which is significantly associated with increased cardiovascular disease risk factors, and erectile dysfunction. Providers should screen TCS for hypogonadism and treat symptomatic patients.
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Affiliation(s)
- Mohammad Abu Zaid
- Indiana University, Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Paul C. Dinh
- Indiana University, Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Patrick O. Monahan
- Indiana University, Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Chunkit Fung
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, New York
| | - Omar El-Charif
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Darren R. Feldman
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NewYork
| | | | - David J. Vaughn
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Clair J. Beard
- Department of Radiation Oncology, Dana-FarberCancer Institute
| | - Ryan Cook
- Indiana University, Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Sandra Althouse
- Indiana University, Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | | | - Howard D. Sesso
- Divisions of Preventive Medicine andAging, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Taisei Mushiroda
- The RIKEN Center for Integrative Medical Science, Yokohama, Japan
| | | | - M. Eileen Dolan
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Lawrence H. Einhorn
- Indiana University, Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Sophie D. Fossa
- Department of Oncology, Oslo University Hospital, Radium Hospital, Oslo, Norway
| | - Lois B. Travis
- Indiana University, Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
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28
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Abstract
PURPOSE OF REVIEW In the present review, we summarize the recent developments in the management of germ cell tumors (GCTs). RECENT FINDINGS Treatment-related acute and late-onset toxicity remains a key challenge in the management of GCTs, with recent evidence showing that the adverse health outcomes of etoposide and cisplatin for four cycles in comparison to bleomycin, etoposide, and cisplatin for three cycles appear to be similar. Recent data showed that multidisciplinary clinic approach and management in experienced academic centers were associated with improved overall survival in GCT patients. There are currently multiple conventional-dose chemotherapy options for salvage therapy in patients with refractory or recurrent disease. In addition, more efficacious high-dose chemotherapy regimens continue to be developed. The role of salvage conventional-dose chemotherapy versus high-dose chemotherapy is currently being investigated prospectively. Recent reports suggested that brentuximab vedotin could be a potential salvage option for cluster of differentiation 30 positive refractory GCTs. On the other hand the results of the first phase II clinical trial investigating pembrolizumab in refractory GCTs were disappointing showing no clinical activity.Finally, deep exploration of the immune profile of GCTs using immunohistochemistry and gene expression profiling has identified that advanced GCT stage was associated with decreased T-cell and Natural killer-cell signatures, whereas T regulatory, neutrophil, mast cell, and macrophage signatures increased with advanced stage. Even though these results indicated that activated T-cell infiltration correlated with seminoma histology and good prognosis, and could be used in the future as a biomarker, this approach needs to be validated in a large cohort. SUMMARY Remaining challenges to be addressed include minimizing therapeutic toxicity, and improving outcomes in patients with refractory/recurrent GCTs.
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Nestler T, Baunacke M, Dräger D, von Landenberg N, Groeben C, Huber J. Testicular cancer guideline adherence and patterns of care in Germany: A nationwide survey. Eur J Cancer Care (Engl) 2018; 28:e12917. [PMID: 30252174 DOI: 10.1111/ecc.12917] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 06/21/2018] [Accepted: 08/19/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Tim Nestler
- Department of Urology; Federal Armed Services Hospital Koblenz; Koblenz Germany
| | - Martin Baunacke
- Department of Urology; University Hospital Dresden; Dresden Germany
| | - Desiree Dräger
- Department of Urology; University Hospital Rostock; Rostock Germany
| | | | - Christer Groeben
- Department of Urology; University Hospital Dresden; Dresden Germany
| | - Johannes Huber
- Department of Urology; University Hospital Dresden; Dresden Germany
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30
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Seo Y, Kim JS, Park ES, Ryu E. Assessment of the awareness and knowledge of cancer survivors regarding the components of metabolic syndrome. PLoS One 2018; 13:e0199142. [PMID: 29920529 PMCID: PMC6007835 DOI: 10.1371/journal.pone.0199142] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 06/02/2018] [Indexed: 11/18/2022] Open
Abstract
This study aimed to assess the prevalence of metabolic syndrome and the level of knowledge and awareness of its related conditions in a sample of cancer survivor patients. In this cross-sectional survey, a self-reported questionnaire was administered to outpatients aged >20 years with a diagnosis of cancer. This self-reported questionnaire on patient demographic characteristics, disease characteristics, and knowledge and awareness of metabolic syndrome was used as an instrument to assess patient's knowledge of metabolic syndrome. A total of 88 participants were included; of these 34.1% had metabolic syndrome, although only 6.8% of participants were diagnosed with metabolic syndrome. Over half of the participants had heard about metabolic syndrome; however, 70% of the participants did not know about the blood tests for the diagnosis of metabolic syndrome although they were aware of the physical measurements, such as weight, blood pressure, and waist circumference. The highest proportion of correct answers for questions about metabolic syndrome was related to stroke, while the lowest was about cholesterol levels. The proportions of correct answers for selected parameters were as follows: diabetes, 39.1%; adiposity, 47.2%; hypertension, 46.8%; cholesterol levels, 36.7%; arteriosclerosis, 45.5%; myocardial infarction, 37.8%; and stroke, 62.8%. The results suggest that the level of knowledge of metabolic syndrome among the cancer survivors in our sample was poor, although more than one-third of them had metabolic syndrome. Thus, it is essential to educate cancer survivors about metabolic syndrome and its related conditions to improve their overall health and quality of life.
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Affiliation(s)
- Yeji Seo
- Student of Graduate school, Chung-Ang University, Seoul, Republic of Korea
| | - Ji-Su Kim
- Faculty of College of Nursing, Chung-Ang University, Seoul, Republic of Korea
- * E-mail:
| | - Eun-shim Park
- Unit Manager, Cardiovascular Center, Seoul Medical Center, Seoul, Republic of Korea
| | - Eunjung Ryu
- Faculty of College of Nursing, Chung-Ang University, Seoul, Republic of Korea
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31
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De Ieso ML, Yool AJ. Mechanisms of Aquaporin-Facilitated Cancer Invasion and Metastasis. Front Chem 2018; 6:135. [PMID: 29922644 PMCID: PMC5996923 DOI: 10.3389/fchem.2018.00135] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/09/2018] [Indexed: 01/02/2023] Open
Abstract
Cancer is a leading cause of death worldwide, and its incidence is rising with numbers expected to increase 70% in the next two decades. The fact that current mainline treatments for cancer patients are accompanied by debilitating side effects prompts a growing demand for new therapies that not only inhibit growth and proliferation of cancer cells, but also control invasion and metastasis. One class of targets gaining international attention is the aquaporins, a family of membrane-spanning water channels with diverse physiological functions and extensive tissue-specific distributions in humans. Aquaporins−1,−2,−3,−4,−5,−8, and−9 have been linked to roles in cancer invasion, and metastasis, but their mechanisms of action remain to be fully defined. Aquaporins are implicated in the metastatic cascade in processes of angiogenesis, cellular dissociation, migration, and invasion. Cancer invasion and metastasis are proposed to be potentiated by aquaporins in boosting tumor angiogenesis, enhancing cell volume regulation, regulating cell-cell and cell-matrix adhesions, interacting with actin cytoskeleton, regulating proteases and extracellular-matrix degrading molecules, contributing to the regulation of epithelial-mesenchymal transitions, and interacting with signaling pathways enabling motility and invasion. Pharmacological modulators of aquaporin channels are being identified and tested for therapeutic potential, including compounds derived from loop diuretics, metal-containing organic compounds, plant natural products, and other small molecules. Further studies on aquaporin-dependent functions in cancer metastasis are needed to define the differential contributions of different classes of aquaporin channels to regulation of fluid balance, cell volume, small solute transport, signal transduction, their possible relevance as rate limiting steps, and potential values as therapeutic targets for invasion and metastasis.
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Affiliation(s)
- Michael L De Ieso
- Department of Physiology, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Andrea J Yool
- Department of Physiology, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
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Kerns SL, Fung C, Monahan PO, Ardeshir-Rouhani-Fard S, Abu Zaid MI, Williams AM, Stump TE, Sesso HD, Feldman DR, Hamilton RJ, Vaughn DJ, Beard C, Huddart RA, Kim J, Kollmannsberger C, Sahasrabudhe DM, Cook R, Fossa SD, Einhorn LH, Travis LB. Cumulative Burden of Morbidity Among Testicular Cancer Survivors After Standard Cisplatin-Based Chemotherapy: A Multi-Institutional Study. J Clin Oncol 2018; 36:1505-1512. [PMID: 29617189 DOI: 10.1200/jco.2017.77.0735] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose In this multicenter study, we evaluated the cumulative burden of morbidity (CBM) among > 1,200 testicular cancer survivors and applied factor analysis to determine the co-occurrence of adverse health outcomes (AHOs). Patients and Methods Participants were ≤ 55 years of age at diagnosis, finished first-line chemotherapy ≥ 1 year previously, completed a comprehensive questionnaire, and underwent physical examination. Treatment data were abstracted from medical records. A CBM score encompassed the number and severity of AHOs, with ordinal logistic regression used to assess associations with exposures. Nonlinear factor analysis and the nonparametric dimensionality evaluation to enumerate contributing traits procedure determined which AHOs co-occurred. Results Among 1,214 participants, approximately 20% had a high (15%) or very high/severe (4.1%) CBM score, whereas approximately 80% scored medium (30%) or low/very low (47%). Increased risks of higher scores were associated with four cycles of either ifosfamide, etoposide, and cisplatin (odds ratio [OR], 1.96; 95% CI, 1.04 to 3.71) or bleomycin, etoposide, and cisplatin (OR, 1.44; 95% CI, 1.04 to 1.98), older attained age (OR, 1.18; 95% CI, 1.10 to 1.26), current disability leave (OR, 3.53; 95% CI, 1.57 to 7.95), less than a college education (OR, 1.44; 95% CI, 1.11 to 1.87), and current or former smoking (OR, 1.28; 95% CI, 1.02 to 1.63). CBM score did not differ after either chemotherapy regimen ( P = .36). Asian race (OR, 0.41; 95% CI, 0.23 to 0.72) and vigorous exercise (OR, 0.68; 95% CI, 0.52 to 0.89) were protective. Variable clustering analyses identified six significant AHO clusters (χ2 P < .001): hearing loss/damage, tinnitus (OR, 16.3); hyperlipidemia, hypertension, diabetes (OR, 9.8); neuropathy, pain, Raynaud phenomenon (OR, 5.5); cardiovascular and related conditions (OR, 5.0); thyroid disease, erectile dysfunction (OR, 4.2); and depression/anxiety, hypogonadism (OR, 2.8). Conclusion Factors associated with higher CBM may identify testicular cancer survivors in need of closer monitoring. If confirmed, identified AHO clusters could guide the development of survivorship care strategies.
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Affiliation(s)
- Sarah L Kerns
- Sarah L. Kerns, Chunkit Fung, AnnaLynn M. Williams, and Deepak M. Sahasrabudhe, University of Rochester Medical Center, Rochester; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Mohammad I. Abu Zaid, Timothy E. Stump, Ryan Cook, Lawrence H. Einhorn, and Lois B. Travis, Indiana University, Indianapolis, IN; Howard D. Sesso, Brigham and Women's Hospital; Clair Beard, Dana-Farber Cancer Institute, Boston, MA; Robert J. Hamilton, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, University of British Columbia, Vancouver, British Columbia, Canada; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; Robert A. Huddart, The Royal Marsden Hospital, London, United Kingdom; Jeri Kim, MD Anderson Cancer Center, Houston, TX; and Sophie D. Fossa, Oslo University Hospital, Oslo, Norway
| | - Chunkit Fung
- Sarah L. Kerns, Chunkit Fung, AnnaLynn M. Williams, and Deepak M. Sahasrabudhe, University of Rochester Medical Center, Rochester; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Mohammad I. Abu Zaid, Timothy E. Stump, Ryan Cook, Lawrence H. Einhorn, and Lois B. Travis, Indiana University, Indianapolis, IN; Howard D. Sesso, Brigham and Women's Hospital; Clair Beard, Dana-Farber Cancer Institute, Boston, MA; Robert J. Hamilton, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, University of British Columbia, Vancouver, British Columbia, Canada; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; Robert A. Huddart, The Royal Marsden Hospital, London, United Kingdom; Jeri Kim, MD Anderson Cancer Center, Houston, TX; and Sophie D. Fossa, Oslo University Hospital, Oslo, Norway
| | - Patrick O Monahan
- Sarah L. Kerns, Chunkit Fung, AnnaLynn M. Williams, and Deepak M. Sahasrabudhe, University of Rochester Medical Center, Rochester; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Mohammad I. Abu Zaid, Timothy E. Stump, Ryan Cook, Lawrence H. Einhorn, and Lois B. Travis, Indiana University, Indianapolis, IN; Howard D. Sesso, Brigham and Women's Hospital; Clair Beard, Dana-Farber Cancer Institute, Boston, MA; Robert J. Hamilton, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, University of British Columbia, Vancouver, British Columbia, Canada; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; Robert A. Huddart, The Royal Marsden Hospital, London, United Kingdom; Jeri Kim, MD Anderson Cancer Center, Houston, TX; and Sophie D. Fossa, Oslo University Hospital, Oslo, Norway
| | - Shirin Ardeshir-Rouhani-Fard
- Sarah L. Kerns, Chunkit Fung, AnnaLynn M. Williams, and Deepak M. Sahasrabudhe, University of Rochester Medical Center, Rochester; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Mohammad I. Abu Zaid, Timothy E. Stump, Ryan Cook, Lawrence H. Einhorn, and Lois B. Travis, Indiana University, Indianapolis, IN; Howard D. Sesso, Brigham and Women's Hospital; Clair Beard, Dana-Farber Cancer Institute, Boston, MA; Robert J. Hamilton, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, University of British Columbia, Vancouver, British Columbia, Canada; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; Robert A. Huddart, The Royal Marsden Hospital, London, United Kingdom; Jeri Kim, MD Anderson Cancer Center, Houston, TX; and Sophie D. Fossa, Oslo University Hospital, Oslo, Norway
| | - Mohammad I Abu Zaid
- Sarah L. Kerns, Chunkit Fung, AnnaLynn M. Williams, and Deepak M. Sahasrabudhe, University of Rochester Medical Center, Rochester; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Mohammad I. Abu Zaid, Timothy E. Stump, Ryan Cook, Lawrence H. Einhorn, and Lois B. Travis, Indiana University, Indianapolis, IN; Howard D. Sesso, Brigham and Women's Hospital; Clair Beard, Dana-Farber Cancer Institute, Boston, MA; Robert J. Hamilton, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, University of British Columbia, Vancouver, British Columbia, Canada; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; Robert A. Huddart, The Royal Marsden Hospital, London, United Kingdom; Jeri Kim, MD Anderson Cancer Center, Houston, TX; and Sophie D. Fossa, Oslo University Hospital, Oslo, Norway
| | - AnnaLynn M Williams
- Sarah L. Kerns, Chunkit Fung, AnnaLynn M. Williams, and Deepak M. Sahasrabudhe, University of Rochester Medical Center, Rochester; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Mohammad I. Abu Zaid, Timothy E. Stump, Ryan Cook, Lawrence H. Einhorn, and Lois B. Travis, Indiana University, Indianapolis, IN; Howard D. Sesso, Brigham and Women's Hospital; Clair Beard, Dana-Farber Cancer Institute, Boston, MA; Robert J. Hamilton, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, University of British Columbia, Vancouver, British Columbia, Canada; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; Robert A. Huddart, The Royal Marsden Hospital, London, United Kingdom; Jeri Kim, MD Anderson Cancer Center, Houston, TX; and Sophie D. Fossa, Oslo University Hospital, Oslo, Norway
| | - Timothy E Stump
- Sarah L. Kerns, Chunkit Fung, AnnaLynn M. Williams, and Deepak M. Sahasrabudhe, University of Rochester Medical Center, Rochester; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Mohammad I. Abu Zaid, Timothy E. Stump, Ryan Cook, Lawrence H. Einhorn, and Lois B. Travis, Indiana University, Indianapolis, IN; Howard D. Sesso, Brigham and Women's Hospital; Clair Beard, Dana-Farber Cancer Institute, Boston, MA; Robert J. Hamilton, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, University of British Columbia, Vancouver, British Columbia, Canada; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; Robert A. Huddart, The Royal Marsden Hospital, London, United Kingdom; Jeri Kim, MD Anderson Cancer Center, Houston, TX; and Sophie D. Fossa, Oslo University Hospital, Oslo, Norway
| | - Howard D Sesso
- Sarah L. Kerns, Chunkit Fung, AnnaLynn M. Williams, and Deepak M. Sahasrabudhe, University of Rochester Medical Center, Rochester; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Mohammad I. Abu Zaid, Timothy E. Stump, Ryan Cook, Lawrence H. Einhorn, and Lois B. Travis, Indiana University, Indianapolis, IN; Howard D. Sesso, Brigham and Women's Hospital; Clair Beard, Dana-Farber Cancer Institute, Boston, MA; Robert J. Hamilton, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, University of British Columbia, Vancouver, British Columbia, Canada; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; Robert A. Huddart, The Royal Marsden Hospital, London, United Kingdom; Jeri Kim, MD Anderson Cancer Center, Houston, TX; and Sophie D. Fossa, Oslo University Hospital, Oslo, Norway
| | - Darren R Feldman
- Sarah L. Kerns, Chunkit Fung, AnnaLynn M. Williams, and Deepak M. Sahasrabudhe, University of Rochester Medical Center, Rochester; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Mohammad I. Abu Zaid, Timothy E. Stump, Ryan Cook, Lawrence H. Einhorn, and Lois B. Travis, Indiana University, Indianapolis, IN; Howard D. Sesso, Brigham and Women's Hospital; Clair Beard, Dana-Farber Cancer Institute, Boston, MA; Robert J. Hamilton, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, University of British Columbia, Vancouver, British Columbia, Canada; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; Robert A. Huddart, The Royal Marsden Hospital, London, United Kingdom; Jeri Kim, MD Anderson Cancer Center, Houston, TX; and Sophie D. Fossa, Oslo University Hospital, Oslo, Norway
| | - Robert J Hamilton
- Sarah L. Kerns, Chunkit Fung, AnnaLynn M. Williams, and Deepak M. Sahasrabudhe, University of Rochester Medical Center, Rochester; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Mohammad I. Abu Zaid, Timothy E. Stump, Ryan Cook, Lawrence H. Einhorn, and Lois B. Travis, Indiana University, Indianapolis, IN; Howard D. Sesso, Brigham and Women's Hospital; Clair Beard, Dana-Farber Cancer Institute, Boston, MA; Robert J. Hamilton, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, University of British Columbia, Vancouver, British Columbia, Canada; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; Robert A. Huddart, The Royal Marsden Hospital, London, United Kingdom; Jeri Kim, MD Anderson Cancer Center, Houston, TX; and Sophie D. Fossa, Oslo University Hospital, Oslo, Norway
| | - David J Vaughn
- Sarah L. Kerns, Chunkit Fung, AnnaLynn M. Williams, and Deepak M. Sahasrabudhe, University of Rochester Medical Center, Rochester; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Mohammad I. Abu Zaid, Timothy E. Stump, Ryan Cook, Lawrence H. Einhorn, and Lois B. Travis, Indiana University, Indianapolis, IN; Howard D. Sesso, Brigham and Women's Hospital; Clair Beard, Dana-Farber Cancer Institute, Boston, MA; Robert J. Hamilton, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, University of British Columbia, Vancouver, British Columbia, Canada; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; Robert A. Huddart, The Royal Marsden Hospital, London, United Kingdom; Jeri Kim, MD Anderson Cancer Center, Houston, TX; and Sophie D. Fossa, Oslo University Hospital, Oslo, Norway
| | - Clair Beard
- Sarah L. Kerns, Chunkit Fung, AnnaLynn M. Williams, and Deepak M. Sahasrabudhe, University of Rochester Medical Center, Rochester; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Mohammad I. Abu Zaid, Timothy E. Stump, Ryan Cook, Lawrence H. Einhorn, and Lois B. Travis, Indiana University, Indianapolis, IN; Howard D. Sesso, Brigham and Women's Hospital; Clair Beard, Dana-Farber Cancer Institute, Boston, MA; Robert J. Hamilton, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, University of British Columbia, Vancouver, British Columbia, Canada; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; Robert A. Huddart, The Royal Marsden Hospital, London, United Kingdom; Jeri Kim, MD Anderson Cancer Center, Houston, TX; and Sophie D. Fossa, Oslo University Hospital, Oslo, Norway
| | - Robert A Huddart
- Sarah L. Kerns, Chunkit Fung, AnnaLynn M. Williams, and Deepak M. Sahasrabudhe, University of Rochester Medical Center, Rochester; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Mohammad I. Abu Zaid, Timothy E. Stump, Ryan Cook, Lawrence H. Einhorn, and Lois B. Travis, Indiana University, Indianapolis, IN; Howard D. Sesso, Brigham and Women's Hospital; Clair Beard, Dana-Farber Cancer Institute, Boston, MA; Robert J. Hamilton, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, University of British Columbia, Vancouver, British Columbia, Canada; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; Robert A. Huddart, The Royal Marsden Hospital, London, United Kingdom; Jeri Kim, MD Anderson Cancer Center, Houston, TX; and Sophie D. Fossa, Oslo University Hospital, Oslo, Norway
| | - Jeri Kim
- Sarah L. Kerns, Chunkit Fung, AnnaLynn M. Williams, and Deepak M. Sahasrabudhe, University of Rochester Medical Center, Rochester; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Mohammad I. Abu Zaid, Timothy E. Stump, Ryan Cook, Lawrence H. Einhorn, and Lois B. Travis, Indiana University, Indianapolis, IN; Howard D. Sesso, Brigham and Women's Hospital; Clair Beard, Dana-Farber Cancer Institute, Boston, MA; Robert J. Hamilton, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, University of British Columbia, Vancouver, British Columbia, Canada; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; Robert A. Huddart, The Royal Marsden Hospital, London, United Kingdom; Jeri Kim, MD Anderson Cancer Center, Houston, TX; and Sophie D. Fossa, Oslo University Hospital, Oslo, Norway
| | - Christian Kollmannsberger
- Sarah L. Kerns, Chunkit Fung, AnnaLynn M. Williams, and Deepak M. Sahasrabudhe, University of Rochester Medical Center, Rochester; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Mohammad I. Abu Zaid, Timothy E. Stump, Ryan Cook, Lawrence H. Einhorn, and Lois B. Travis, Indiana University, Indianapolis, IN; Howard D. Sesso, Brigham and Women's Hospital; Clair Beard, Dana-Farber Cancer Institute, Boston, MA; Robert J. Hamilton, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, University of British Columbia, Vancouver, British Columbia, Canada; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; Robert A. Huddart, The Royal Marsden Hospital, London, United Kingdom; Jeri Kim, MD Anderson Cancer Center, Houston, TX; and Sophie D. Fossa, Oslo University Hospital, Oslo, Norway
| | - Deepak M Sahasrabudhe
- Sarah L. Kerns, Chunkit Fung, AnnaLynn M. Williams, and Deepak M. Sahasrabudhe, University of Rochester Medical Center, Rochester; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Mohammad I. Abu Zaid, Timothy E. Stump, Ryan Cook, Lawrence H. Einhorn, and Lois B. Travis, Indiana University, Indianapolis, IN; Howard D. Sesso, Brigham and Women's Hospital; Clair Beard, Dana-Farber Cancer Institute, Boston, MA; Robert J. Hamilton, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, University of British Columbia, Vancouver, British Columbia, Canada; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; Robert A. Huddart, The Royal Marsden Hospital, London, United Kingdom; Jeri Kim, MD Anderson Cancer Center, Houston, TX; and Sophie D. Fossa, Oslo University Hospital, Oslo, Norway
| | - Ryan Cook
- Sarah L. Kerns, Chunkit Fung, AnnaLynn M. Williams, and Deepak M. Sahasrabudhe, University of Rochester Medical Center, Rochester; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Mohammad I. Abu Zaid, Timothy E. Stump, Ryan Cook, Lawrence H. Einhorn, and Lois B. Travis, Indiana University, Indianapolis, IN; Howard D. Sesso, Brigham and Women's Hospital; Clair Beard, Dana-Farber Cancer Institute, Boston, MA; Robert J. Hamilton, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, University of British Columbia, Vancouver, British Columbia, Canada; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; Robert A. Huddart, The Royal Marsden Hospital, London, United Kingdom; Jeri Kim, MD Anderson Cancer Center, Houston, TX; and Sophie D. Fossa, Oslo University Hospital, Oslo, Norway
| | - Sophie D Fossa
- Sarah L. Kerns, Chunkit Fung, AnnaLynn M. Williams, and Deepak M. Sahasrabudhe, University of Rochester Medical Center, Rochester; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Mohammad I. Abu Zaid, Timothy E. Stump, Ryan Cook, Lawrence H. Einhorn, and Lois B. Travis, Indiana University, Indianapolis, IN; Howard D. Sesso, Brigham and Women's Hospital; Clair Beard, Dana-Farber Cancer Institute, Boston, MA; Robert J. Hamilton, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, University of British Columbia, Vancouver, British Columbia, Canada; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; Robert A. Huddart, The Royal Marsden Hospital, London, United Kingdom; Jeri Kim, MD Anderson Cancer Center, Houston, TX; and Sophie D. Fossa, Oslo University Hospital, Oslo, Norway
| | - Lawrence H Einhorn
- Sarah L. Kerns, Chunkit Fung, AnnaLynn M. Williams, and Deepak M. Sahasrabudhe, University of Rochester Medical Center, Rochester; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Mohammad I. Abu Zaid, Timothy E. Stump, Ryan Cook, Lawrence H. Einhorn, and Lois B. Travis, Indiana University, Indianapolis, IN; Howard D. Sesso, Brigham and Women's Hospital; Clair Beard, Dana-Farber Cancer Institute, Boston, MA; Robert J. Hamilton, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, University of British Columbia, Vancouver, British Columbia, Canada; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; Robert A. Huddart, The Royal Marsden Hospital, London, United Kingdom; Jeri Kim, MD Anderson Cancer Center, Houston, TX; and Sophie D. Fossa, Oslo University Hospital, Oslo, Norway
| | - Lois B Travis
- Sarah L. Kerns, Chunkit Fung, AnnaLynn M. Williams, and Deepak M. Sahasrabudhe, University of Rochester Medical Center, Rochester; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Mohammad I. Abu Zaid, Timothy E. Stump, Ryan Cook, Lawrence H. Einhorn, and Lois B. Travis, Indiana University, Indianapolis, IN; Howard D. Sesso, Brigham and Women's Hospital; Clair Beard, Dana-Farber Cancer Institute, Boston, MA; Robert J. Hamilton, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, University of British Columbia, Vancouver, British Columbia, Canada; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; Robert A. Huddart, The Royal Marsden Hospital, London, United Kingdom; Jeri Kim, MD Anderson Cancer Center, Houston, TX; and Sophie D. Fossa, Oslo University Hospital, Oslo, Norway
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Toxicities Associated with Cisplatin-Based Chemotherapy and Radiotherapy in Long-Term Testicular Cancer Survivors. Adv Urol 2018; 2018:8671832. [PMID: 29670654 PMCID: PMC5835297 DOI: 10.1155/2018/8671832] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/06/2017] [Indexed: 12/16/2022] Open
Abstract
Testicular cancer has become the paradigm of adult-onset cancer survivorship, due to the young age at diagnosis and 10-year relative survival of 95%. This clinical review presents the current status of various treatment-related complications experienced by long-term testicular cancer survivors (TCS) free of disease for 5 or more years after primary treatment. Cardiovascular disease and second malignant neoplasms represent the most common potentially life-threatening late effects. Other long-term adverse outcomes include neuro- and ototoxicity, pulmonary complications, nephrotoxicity, hypogonadism, infertility, and avascular necrosis. Future research efforts should focus on delineation of the genetic underpinning of these long-term toxicities to understand their biologic basis and etiopathogenetic pathways, with the goal of developing targeted prevention and intervention strategies to optimize risk-based care and minimize chronic morbidities. In the interim, health care providers should advise TCS to adhere to national guidelines for the management of cardiovascular disease risk factors, as well as to adopt behaviors consistent with a healthy lifestyle, including smoking cessation, a balanced diet, and a moderate to vigorous intensity exercise program. TCS should also follow national guidelines for cancer screening as currently applied to the general population.
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Predicting Cardiovascular Disease Among Testicular Cancer Survivors After Modern Cisplatin-based Chemotherapy: Application of the Framingham Risk Score. Clin Genitourin Cancer 2018. [PMID: 29534941 DOI: 10.1016/j.clgc.2018.01.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Testicular cancer survivors (TCSs) are at increased risk of cardiovascular disease (CVD) after cisplatin-based chemotherapy (CBCT). Identifying at-risk survivors would allow early intervention, but risk prediction tools such as the Framingham Risk Score (FRS) have not been applied to TCSs given modern chemotherapy. METHODS TCSs > 1 year post-CBCT were evaluated. Associations between FRS and clinical, socioeconomic, and lifestyle measures and treatment regimen (4 cycles, etoposide and cisplatin [EP × 4]); 3 or 4 cycles, bleomycin plus EP (BEP × 3, BEP × 4) were analyzed with general linear multivariable models. Controls from the National Health and Nutrition Examination Survey were matched 1:1 to TCSs by age, race, and education with differences in mean FRS evaluated with 2-sided t tests. RESULTS Of 787 TCSs (median age, 37.3 years; median follow-up, 4.2 years), 284, 342, and 161 received EP × 4, BEP × 3, or BEP × 4, respectively. TCSs had higher median systolic blood pressure (126 vs. 119 mm Hg; P < .001), but fewer were smokers (8.4% vs. 28.2%; P < .001) than controls. In multivariable analysis, no significant differences in FRS between EP × 4, BEP × 3, and BEP × 4 were observed, but less than college education (P < .001) and lack of vigorous exercise (P = .006) were associated with higher FRS. Mean FRS did not differ between TCSs and controls (6.8% vs. 7.3%; P = .67). CONCLUSION This is the first study to apply the office-based FRS to TCSs. Chemotherapy regimen (BEP × 3 vs. EP × 4) was not associated with FRS, but less educated and less vigorously active patients had higher FRS, and present a high-risk subgroup for intense follow-up and counseling.
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IJpma I, Renken RJ, Gietema JA, Slart RH, Mensink MG, Lefrandt JD, Ter Horst GJ, Reyners AK. Changes in taste and smell function, dietary intake, food preference, and body composition in testicular cancer patients treated with cisplatin-based chemotherapy. Clin Nutr 2017; 36:1642-1648. [DOI: 10.1016/j.clnu.2016.10.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/28/2016] [Accepted: 10/13/2016] [Indexed: 10/20/2022]
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Leydig cell dysfunction, systemic inflammation and metabolic syndrome in long-term testicular cancer survivors. Eur J Cancer 2017; 84:9-17. [DOI: 10.1016/j.ejca.2017.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 06/26/2017] [Accepted: 07/04/2017] [Indexed: 11/19/2022]
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Long-term cardiovascular complications in stage I seminoma patients. Clin Transl Oncol 2017; 19:1400-1408. [PMID: 28852960 PMCID: PMC5635068 DOI: 10.1007/s12094-017-1742-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/17/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE The cure rate of stage I seminoma patients is close to 100% and so the recent focus of clinical research has shifted onto the prevention of treatment-related complications. We assessed long-term cardiovascular complications and identified risk factors for cardiovascular events (CVEs) in stage I seminoma patients. METHODS This retrospective cohort study included 406 consecutive stage I seminoma patients. Primary endpoint was CVE rate. RESULTS During a median follow-up of 8.6 years, we observed 23 CVEs in 406 patients [10-year CVE risk 5.6% (95% CI 3.2 to 8.8)]. In univariable competing risk analysis, higher age, positive smoking status, history of diabetes and hypertension were significantly associated with the occurrence of CVE. In multi-state analysis, new onset of diabetes, hypertension and hyperlipidemia during follow-up predicted for an excessively increased CVE risk. In multivariable analysis adjusting for age and smoking, the development of hypertension and hyperlipidemia after tumor-specific treatment prevailed as risk factors for CVE. Regarding adjuvant treatment modalities, patients receiving adjuvant radiotherapy had a significantly higher probability of CVE than patients receiving adjuvant carboplatin [16% vs. 0%; risk difference (RD) = 16%, 95% CI 6 to 25%, p = 0.001]. This difference prevailed after adjusting for age, follow-up-time, diabetes, hypertension and smoking (RD = 11%, 95% CI 1 to 20%, p = 0.025). CONCLUSION We identified a panel of baseline risk factors and dynamically, occurring predictors of CVE in stage I seminoma patients. This information may be used for targeting comorbidity management in these patients. The observed association of adjuvant radiotherapy with higher CVE risk warrants further investigation.
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Bandak M, Jørgensen N, Juul A, Lauritsen J, Kreiberg M, Oturai PS, Helge JW, Daugaard G. A randomized double-blind study of testosterone replacement therapy or placebo in testicular cancer survivors with mild Leydig cell insufficiency (Einstein-intervention). BMC Cancer 2017; 17:461. [PMID: 28673265 PMCID: PMC5494856 DOI: 10.1186/s12885-017-3456-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elevated serum levels of luteinizing hormone and slightly decreased serum levels of testosterone (mild Leydig cell insufficiency) is a common hormonal disturbance in testicular cancer (TC) survivors. A number of studies have shown that low serum levels of testosterone is associated with low grade inflammation and increased risk of metabolic syndrome. However, so far, no studies have evaluated whether testosterone substitution improves metabolic dysfunction in TC survivors with mild Leydig cell insufficiency. METHODS/DESIGN This is a single-center, randomized, double-blind, placebo-controlled study, designed to evaluate the effect of testosterone replacement therapy in TC survivors with mild Leydig cell insufficiency. Seventy subjects will be randomized to receive either testosterone replacement therapy or placebo. The subjects will be invited for an information meeting where informed consent will be obtained. Afterwards, a 52-weeks treatment period begins in which study participants will receive a daily dose of transdermal testosterone or placebo. Dose adjustment will be made three times during the initial 8 weeks of the study to a maximal daily dose of 40 mg of testosterone in the intervention arm. Evaluation of primary and secondary endpoints will be performed at baseline, 26 weeks post-randomization, at the end of treatment (52 weeks) and 3 months after completion of treatment (week 64). DISCUSSION This study is the first to investigate the effect of testosterone substitution in testicular cancer survivors with mild Leydig cell insufficiency. If positive, it may change the clinical handling of testicular cancer survivors with borderline low levels of testosterone. TRIAL REGISTRATION ClinicalTrials.gov : NCT02991209 (November 25, 2016).
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Affiliation(s)
- Mikkel Bandak
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Niels Jørgensen
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), University of Copenhagen, Copenhagen, Denmark
| | - Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), University of Copenhagen, Copenhagen, Denmark
| | - Jakob Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Michael Kreiberg
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Peter Sandor Oturai
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jørn Wulff Helge
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
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39
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Wiechno PJ, Poniatowska GM, Michalski W, Kucharz J, Sadowska M, Jonska-Gmyrek J, Nietupski K, Rzymowska J, Demkow T. Clinical significance of androgen secretion disorders in men with a malignancy. Med Oncol 2017; 34:123. [PMID: 28573637 PMCID: PMC5486517 DOI: 10.1007/s12032-017-0982-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/24/2017] [Indexed: 01/16/2023]
Abstract
Cancer and its treatment can lead in men to testosterone deficiency, accompanied by somatic and mental symptoms. Germ cell tumours and their treatment may disturb the pituitary-gonadal axis, hence leading to significant clinical abnormalities. In some prostate cancer patients, castration, temporary or permanent, is a desired therapeutic condition. Yet, it is burdened with various side effects of complex intensity and significance. Last but not least, patients in the terminal stage of a malignancy present with low testosterone concentrations as a part of anorexia-cachexia syndrome. Oncological management of such patients disturbs their homeostasis, androgen metabolism included, which results in numerous complications and worsens their quality of life. In the present paper, we analysed the frequency and sequelae of testosterone deficiency in some clinical scenarios, on the basis of original papers, meta-analyses and reviews available in PubMed. Androgen secretion disorders in male cancer patients depend on a cancer type, stage and methods of treatment. Number of testicular cancer survivors is increasing, and as a consequence, more patients cope with late complications, testosterone deficiency included. Hormone therapy in prostate cancer patients significantly prolongs survival, and then numerous men experience long-term adverse effects of androgen deficiency. Those, in turn, particularly the metabolic syndrome, may contribute to increased mortality. Androgen deficiency is a part of cancer anorexia-cachexia syndrome. The role of androgen deficiency in cancer patients is still under debate, and further studies are urgently needed to establish appropriate clinical guidelines.
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Affiliation(s)
- Pawel J Wiechno
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5 st, 02-781, Warsaw, Poland
| | - Grazyna M Poniatowska
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5 st, 02-781, Warsaw, Poland
| | - Wojciech Michalski
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5 st, 02-781, Warsaw, Poland
| | - Jakub Kucharz
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5 st, 02-781, Warsaw, Poland.
- Department of Experimental and Clinical Surgery, Jagiellonian University Medical College, Michalowskiego 12 st, Kraków, Poland.
| | - Malgorzata Sadowska
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5 st, 02-781, Warsaw, Poland
| | - Joanna Jonska-Gmyrek
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5 st, 02-781, Warsaw, Poland
| | - Karol Nietupski
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5 st, 02-781, Warsaw, Poland
| | - Joanna Rzymowska
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5 st, 02-781, Warsaw, Poland
| | - Tomasz Demkow
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5 st, 02-781, Warsaw, Poland
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40
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Bandak M, Jørgensen N, Juul A, Lauritsen J, Kier MGG, Mortensen MS, Oturai PS, Mortensen J, Hojman P, Helge JW, Daugaard G. Reproductive hormones and metabolic syndrome in 24 testicular cancer survivors and their biological brothers. Andrology 2017; 5:718-724. [PMID: 28598554 DOI: 10.1111/andr.12355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/30/2017] [Accepted: 02/07/2017] [Indexed: 01/22/2023]
Abstract
Testicular cancer survivors have impaired gonadal function and increased risk of metabolic syndrome when compared to healthy controls. However, because of the fetal etiology of testicular cancer, familial unrelated healthy men might not be an optimal control group. The objective of this study was to clarify if testicular cancer survivors have impaired gonadal function and increased risk of metabolic syndrome when compared to their biological brothers. A cross-sectional study of testicular cancer survivors (ClinicalTrials.gov number, NCT02240966) was conducted between 2014 and 2016. Of 158 testicular cancer survivors included, 24 had a biological brother who accepted to participate in the study. Serum levels of reproductive hormones and prevalence of metabolic syndrome according to International Diabetes Federation Criteria and National Cholesterol Education Program (Adult Treatment Panel III) criteria comprised the main outcome measures of the study. Median age was similar in testicular cancer survivors and their biological brothers [44 years (IQR 39-50) vs. 46 (40-53) years respectively (p = 0.1)]. In testicular cancer survivors, follow-up since treatment was 12 years (7-19). Serum levels of luteinizing hormone and follicle-stimulating hormone were elevated (p ≤ 0.001), while total testosterone, free testosterone, inhibin B and anti-Müllerian hormone were lower (p ≤ 0.001) in testicular cancer survivors than in their biological brothers. The prevalence of metabolic syndrome was similar and apart from HDL-cholesterol, which was lower in testicular cancer survivors (p = 0.01); there were no differences in the individual components of the metabolic syndrome between testicular cancer survivors and their brothers. In conclusion, gonadal function was impaired in testicular cancer survivors, while we did not detect any difference in the prevalence of metabolic syndrome between testicular cancer survivors and their biological brothers.
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Affiliation(s)
- M Bandak
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - N Jørgensen
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), University of Copenhagen, Copenhagen, Denmark
| | - A Juul
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), University of Copenhagen, Copenhagen, Denmark
| | - J Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - M G G Kier
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Unit of Survivorship, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - M S Mortensen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - P S Oturai
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - J Mortensen
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - P Hojman
- Centre of Physical Activity Research, Centre of Inflammation and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - J W Helge
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - G Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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41
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Bogefors C, Isaksson S, Bobjer J, Kitlinski M, Leijonhufvud I, Link K, Giwercman A. Hypogonadism in testicular cancer patients is associated with risk factors of cardiovascular disease and the metabolic syndrome. Andrology 2017; 5:711-717. [DOI: 10.1111/andr.12354] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 02/03/2017] [Accepted: 02/05/2017] [Indexed: 02/06/2023]
Affiliation(s)
- C. Bogefors
- Molecular Reproductive Medicine Unit; Department of Translational Medicine; Lund University; Malmö Sweden
- Department of Oncology; Skane University Hospital; Malmö and Lund Sweden
| | - S. Isaksson
- Molecular Reproductive Medicine Unit; Department of Translational Medicine; Lund University; Malmö Sweden
- Department of Oncology; Skane University Hospital; Malmö and Lund Sweden
| | - J. Bobjer
- Molecular Reproductive Medicine Unit; Department of Translational Medicine; Lund University; Malmö Sweden
| | - M. Kitlinski
- Department of Cardiology; Skane University Hospital; Malmö Sweden
| | - I. Leijonhufvud
- Molecular Reproductive Medicine Unit; Department of Translational Medicine; Lund University; Malmö Sweden
- Reproductive Medicine Centre; Skane University Hospital; Malmö Sweden
| | - K. Link
- Reproductive Medicine Centre; Skane University Hospital; Malmö Sweden
| | - A. Giwercman
- Molecular Reproductive Medicine Unit; Department of Translational Medicine; Lund University; Malmö Sweden
- Reproductive Medicine Centre; Skane University Hospital; Malmö Sweden
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Abstract
PURPOSE OF REVIEW In the present review, we summarize the recent developments in the management of germ cell tumors (GCTs). RECENT FINDINGS Treatment-related acute and late-onset toxicity remains a key challenge in the management of GCTs. Recent data show that patients with large retroperitoneal lymph node metastases are at increased risk of venous thromboembolism and may benefit from prophylactic anticoagulation. Predictive models have been developed to identify patients with residual retroperitoneal lymph node masses who are more likely to benefit from surgical resection. However, their clinical use remains hampered by relatively low accuracy. There are currently multiple conventional-dose chemotherapy (CDCT) options for salvage therapy in patients with refractory or recurrent disease. In addition, more efficacious high-dose chemotherapy (HDCT) regimens continue to be developed. The role of salvage CDCT versus HDCT is currently being prospectively investigated.Finally, intratumoral heterogeneity is a common finding in cancer and an obvious observation in GCTs. Despite intratumoral heterogeneity, recent studies on nonseminomatous GCT have identified distinct histological subgroups and a potentially lethal clinical phenotype. Importantly, comprehensive molecular profiling so far has not elucidated the biologic basis or the clinical underpinnings of intratumoral heterogeneity in GCTs. SUMMARY Remaining challenges to be addressed include minimizing therapeutic toxicity and improving outcomes in patients with refractory/recurrent GCTs or malignant transformation of teratomas.
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43
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Bandak M, Jørgensen N, Juul A, Lauritsen J, Kier MGG, Mortensen MS, Daugaard G. Longitudinal Changes in Serum Levels of Testosterone and Luteinizing Hormone in Testicular Cancer Patients after Orchiectomy Alone or Bleomycin, Etoposide, and Cisplatin. Eur Urol Focus 2016; 4:591-598. [PMID: 28753832 DOI: 10.1016/j.euf.2016.11.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 11/23/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Controversy exists whether Leydig cells recover after testicular cancer (TC) treatment or whether premature hormonal aging will occur. OBJECTIVE Evaluate serial changes in total testosterone (TT) and luteinizing hormone (LH) in patients treated with orchiectomy alone (Stage I) or combination chemotherapy with bleomycin, etoposide, and cisplatin (BEP). DESIGN, SETTINGS, AND PARTICIPANTS Changes in TT and LH were investigated during 5-yr follow-up (Stage I: n=75, BEP: n=81). A selected group of TC patients with mild Leydig cell dysfunction (LH ≥ 8 IU/l) were followed for a longer period (Stage I: n=20, BEP: n=23). An age-matched control group of 839 healthy men served as controls for TT and LH levels. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Changes in age-adjusted TT and LH were evaluated separately in each treatment group with univariate linear regression analysis. The proportion of patients initiating testosterone substitution during follow-up was calculated. RESULTS AND LIMITATIONS In the 75 Stage I patients there were no significant changes in LH and TT, while in the 81 BEP treated patients there was a significant decline in LH during follow-up (-24.2 percentage point/yr, 95% confidence interval: -38.5 to -9.9, p=0.001). In total, 11% of Stage I patients and 15% of BEP-treated patients initiated testosterone substitution. In the 23 BEP-treated patients with mild Leydig cell dysfunction there was a significant decline in age-adjusted TT (-0.9 percentage point/yr, 95% confidence interval: -1.8 to -0.04, p=0.04), while in the 20 Stage I patients there were no significant changes in age-adjusted LH and TT. Limitations include the retrospective study design. CONCLUSIONS TT remained stable during 5-yr follow-up in TC patients treated with orchiectomy alone or BEP. BEP-treated patients with mild Leydig cell dysfunction during follow-up were at risk of long-term testicular failure and evaluation of Leydig cell function beyond follow-up should be considered in this group of patients. PATIENT SUMMARY This study shows that the majority of testicular cancer survivors had stable testosterone levels after treatment for testicular cancer. However, 11-15% of patients needed testosterone substitution after treatment.
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Affiliation(s)
- Mikkel Bandak
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | - Niels Jørgensen
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Denmark
| | - Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Denmark
| | - Jakob Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Maria Gry Gundgaard Kier
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark; Unit of Survivorship, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | | | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark
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44
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Chevreau C, Gladieff L, Faure-Conter C. [Germ cell tumor in adolescents and young adults]. Bull Cancer 2016; 103:1057-1063. [PMID: 27823808 DOI: 10.1016/j.bulcan.2016.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 11/28/2022]
Abstract
Management of extracranial germ cell tumors (TG) is emblematic of the adolescents and young adults' problematic. Beyond persisting differences in care between adult and pediatric oncologists, it emphasizes the need for effective collaboration between both teams. If the therapy is primarily guided today by adult standards, pediatricians bring expertise in long-term follow-up, justified by the increasing description of late side effects in this young population, with highly curable disease since cisplatin's emergence.
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Affiliation(s)
- Christine Chevreau
- Institut Claudius-Regaud, IUCT-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - Laurence Gladieff
- Institut Claudius-Regaud, IUCT-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - Cécile Faure-Conter
- Institut d'hémato-oncologie pédiatrique, 1, place J.-Renaud, 69008 Lyon, France.
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45
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Westerink NL, Nuver J, Lefrandt JD, Vrieling AH, Gietema JA, Walenkamp AME. Cancer treatment induced metabolic syndrome: Improving outcome with lifestyle. Crit Rev Oncol Hematol 2016; 108:128-136. [PMID: 27931830 DOI: 10.1016/j.critrevonc.2016.10.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 08/26/2016] [Accepted: 10/26/2016] [Indexed: 12/19/2022] Open
Abstract
Increasing numbers of long-term cancer survivors face important treatment related adverse effects. Cancer treatment induced metabolic syndrome (CTIMetS) is an especially prevalent and harmful condition. The aetiology of CTIMetS likely differs from metabolic syndrome in the general population, but effective treatment and prevention methods are probably similar. In this review, we summarize the potential mechanisms leading to the development of CTIMetS after various types of cancer treatment. Furthermore, we propose a safe and accessible method to treat or prevent CTIMetS through lifestyle change. In particular, we suggest that a lifestyle intervention and optimization of energy balance can prevent or mitigate the development of CTIMetS, which may contribute to optimal survivorship care.
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Affiliation(s)
- N L Westerink
- Department of Medical Oncology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - J Nuver
- Department of Medical Oncology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - J D Lefrandt
- Department of Vascular Medicine, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - A H Vrieling
- Department of Rehabilitation Medicine, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - J A Gietema
- Department of Medical Oncology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - A M E Walenkamp
- Department of Medical Oncology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
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46
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Shah S, Ward JE, Bao R, Hall CR, Brockstein BE, Luke JJ. Clinical Response of a Patient to Anti-PD-1 Immunotherapy and the Immune Landscape of Testicular Germ Cell Tumors. Cancer Immunol Res 2016; 4:903-909. [PMID: 27638840 DOI: 10.1158/2326-6066.cir-16-0087] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 08/17/2016] [Indexed: 12/20/2022]
Abstract
Anti-Programed Death 1 (PD-1) is standard immunotherapy for multiple cancers, and the expression of one of its ligands, PD-L1, has been described in germ cell tumors (GCT). Neither the clinical activity of anti-PD-1 nor the incidence of an immunoresponsive tumor microenvironment has been described for GCTs. A patient initially diagnosed with melanoma via fine needle aspiration was treated with one dose of antibody to PD-1. A core needle biopsy was subsequently performed to acquire sufficient tissue for molecular analysis, which led to a change in diagnosis to metastatic embryonal carcinoma. The testicular GCT cohort of The Cancer Genome Atlas was analyzed using a T-cell gene signature associated with benefit from immunotherapy. Primary tumors (N = 134) were categorized as high (T-cell-inflamed), medium, or low (non-T-cell-inflamed) by their T-cell signature derived from RNAseq data. Anti-PD-1 induced decreases in serum markers and a 33% reduction in tumor volume. Gene expression revealed a T-cell-inflamed tumor microenvironment in 47% of testicular GCTs, including seminoma (83%) and nonseminoma (17%) tumor subtypes. Expression of alpha-fetoprotein (AFP) RNA correlated with lack of the T-cell signature, with increasing AFP RNA inversely correlating with the inflamed signature and expression of IFNγ-associated genes. These data suggest that GCTs can respond to anti-PD-1 and that gene expression profiling supports investigation of immunotherapy for treatment of GCTs. Cancer Immunol Res; 4(11); 903-9. ©2016 AACR.
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Affiliation(s)
- Shalin Shah
- Northshore University HealthSystem, Evanston, Illinois
| | - James E Ward
- Northshore University HealthSystem, Evanston, Illinois.,University of Chicago, Chicago, Illinois
| | - Riyue Bao
- University of Chicago, Chicago, Illinois
| | - Curtis R Hall
- Northshore University HealthSystem, Evanston, Illinois.,University of Chicago, Chicago, Illinois
| | - Bruce E Brockstein
- Northshore University HealthSystem, Evanston, Illinois.,University of Chicago, Chicago, Illinois
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47
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Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, Stein KD, Alteri R, Jemal A. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 2016; 66:271-89. [PMID: 27253694 DOI: 10.3322/caac.21349] [Citation(s) in RCA: 3437] [Impact Index Per Article: 429.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The number of cancer survivors continues to increase because of both advances in early detection and treatment and the aging and growth of the population. For the public health community to better serve these survivors, the American Cancer Society and the National Cancer Institute collaborate to estimate the number of current and future cancer survivors using data from the Surveillance, Epidemiology, and End Results cancer registries. In addition, current treatment patterns for the most prevalent cancer types are presented based on information in the National Cancer Data Base and treatment-related side effects are briefly described. More than 15.5 million Americans with a history of cancer were alive on January 1, 2016, and this number is projected to reach more than 20 million by January 1, 2026. The 3 most prevalent cancers are prostate (3,306,760), colon and rectum (724,690), and melanoma (614,460) among males and breast (3,560,570), uterine corpus (757,190), and colon and rectum (727,350) among females. More than one-half (56%) of survivors were diagnosed within the past 10 years, and almost one-half (47%) are aged 70 years or older. People with a history of cancer have unique medical and psychosocial needs that require proactive assessment and management by primary care providers. Although there are a growing number of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care. CA Cancer J Clin 2016;66:271-289. © 2016 American Cancer Society.
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Affiliation(s)
- Kimberly D Miller
- Epidemiologist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Rebecca L Siegel
- Strategic Director, Surveillance Information, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Chun Chieh Lin
- Director, Health Services Research, Intramural Research Department, American Cancer Society, Atlanta, GA
| | - Angela B Mariotto
- Branch Chief, Surveillance Research Program, National Cancer Institute, Bethesda, MD
| | - Joan L Kramer
- Assistant Professor, Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Julia H Rowland
- Director, Office of Cancer Survivorship, National Cancer Institute, Bethesda, MD
| | - Kevin D Stein
- Vice President, Behavioral Research Center, American Cancer Society, Atlanta, GA
| | - Rick Alteri
- Medical Editor, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Vice President, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
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48
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IJpma I, Renken RJ, Gietema JA, Slart RHJA, Mensink MGJ, Lefrandt JD, Ter Horst GJ, Reyners AKL. Taste and smell function in testicular cancer survivors treated with cisplatin-based chemotherapy in relation to dietary intake, food preference, and body composition. Appetite 2016; 105:392-9. [PMID: 27298084 DOI: 10.1016/j.appet.2016.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/11/2016] [Accepted: 06/08/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chemotherapy can affect taste and smell function. This may contribute to the high prevalence of overweight and metabolic syndrome in testicular cancer survivors (TCS). Aims of the study were to evaluate taste and smell function and possible consequences for dietary intake, food preference, and body composition in TCS treated with cisplatin-based chemotherapy. METHODS Fifty TCS, 1-7 years post-chemotherapy, and 50 age-matched healthy men participated. Taste and smell function were measured using taste strips and 'Sniffin' Sticks', respectively. Dietary intake was investigated using a food frequency questionnaire. Food preference was assessed using food pictures varying in taste (sweet/savoury) and fat or protein content. Dual-Energy X-ray Absorptiometry was performed to measure body composition. Presence of metabolic syndrome and hypogonadism were assessed. RESULTS TCS had a lower total taste function, a higher bitter taste threshold, higher Body Mass Index (BMI), and more (abdominal) fat than controls (p < 0.05). No differences in smell function and dietary intake were found. Testosterone level was an important determinant of body composition in TCS (p = 0.016). CONCLUSION Although taste function was impaired in TCS, this was not related to a different dietary intake compared to controls. Lower testosterone levels were associated with a higher BMI, fat mass, and abdominal fat distribution in TCS.
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Affiliation(s)
- Irene IJpma
- Top Institute Food and Nutrition, Wageningen, The Netherlands; Neuroimaging Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Remco J Renken
- Top Institute Food and Nutrition, Wageningen, The Netherlands; Neuroimaging Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jourik A Gietema
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Riemer H J A Slart
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Faculty of Science and Technology, Biomedical Photonic Imaging, University of Twente, The Netherlands
| | - Manon G J Mensink
- Top Institute Food and Nutrition, Wageningen, The Netherlands; Food & Biobased Research, Wageningen UR, Wageningen, The Netherlands
| | - Joop D Lefrandt
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gert J Ter Horst
- Top Institute Food and Nutrition, Wageningen, The Netherlands; Neuroimaging Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anna K L Reyners
- Top Institute Food and Nutrition, Wageningen, The Netherlands; Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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49
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Hashibe M, Abdelaziz S, Al-Temimi M, Fraser A, Boucher KM, Smith K, Lee YCA, Rowe K, Rowley B, Daurelle M, Holton AE, VanDerslice J, Richiardi L, Bishoff J, Lowrance W, Stroup A. Long-term health effects among testicular cancer survivors. J Cancer Surviv 2016; 10:1051-1057. [PMID: 27169992 DOI: 10.1007/s11764-016-0548-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 05/03/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Testicular cancer is diagnosed at a young age and survival rates are high; thus, the long-term effects of cancer treatment need to be assessed. Our objectives are to estimate the incidence rates and determinants of late effects in testicular cancer survivors. METHODS We conducted a population-based cohort study of testicular cancer survivors, diagnosed 1991-2007, followed up for a median of 10 years. We identified 785 testicular cancer patients who survived ≥5 years and 3323 men free of cancer for the comparison group. Multivariate Cox regression analysis was used to compare the hazard ratio between the cases and the comparison group and for internal analysis among case patients. RESULTS Testicular cancer survivors experienced a 24 % increase in risk of long-term health effects >5 years after diagnosis. The overall incidence rate of late effects among testicular cancer survivors was 66.3 per 1000 person years. Higher risks were observed among testicular cancer survivors for hypercholesterolemia, infertility, and orchitis. Chemotherapy and retroperitoneal lymph node dissection appeared to increase the risk of late effects. Being obese prior to cancer diagnosis appeared to be the strongest factor associated with late effects. CONCLUSIONS Testicular cancer survivors were more likely to develop chronic health conditions when compared to cancer-free men. IMPLICATIONS FOR CANCER SURVIVORS While the late effects risk was increased among testicular cancer survivors, the incidence rates of late effects after cancer diagnosis was fairly low.
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Affiliation(s)
- Mia Hashibe
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT, USA. .,Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, 84108, USA.
| | - Sarah Abdelaziz
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, 84108, USA
| | - Mohammed Al-Temimi
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT, USA
| | - Alison Fraser
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Kenneth M Boucher
- Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, 84108, USA.,Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ken Smith
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Yuan-Chin Amy Lee
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT, USA
| | - Kerry Rowe
- Medical Informatics, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Braden Rowley
- Medical Informatics, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Micky Daurelle
- University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Avery E Holton
- Department of Communication, University of Utah, Salt Lake City, UT, USA
| | - James VanDerslice
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT, USA
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Jay Bishoff
- Intermountain Urological Institute, Salt Lake City, UT, USA
| | - Will Lowrance
- Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, 84108, USA.,Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Antoinette Stroup
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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50
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Abstract
Testicular germ cell tumours are at the crossroads of developmental and neoplastic processes. Their cause has not been fully elucidated but differences in incidences suggest that a combination of genetic and environment factors are involved, with environmental factors predominating early in life. Substantial progress has been made in understanding genetic susceptibility in the past 5 years on the basis of the results of large genome-wide association studies. Testicular germ cell tumours are highly sensitive to radiotherapy and chemotherapy and hence have among the best outcomes of all tumours. Because the tumours occur mainly in young men, preservation of reproductive function, quality of life after treatment, and late effects are crucial concerns. In this Seminar, we provide an overview of advances in the understanding of the epidemiology, genetics, and biology of testicular germ cell tumours. We also summarise the consensus on how to treat testicular germ cell tumours and focus on a few controversies and improvements in the understanding of late effects of treatment and quality of life for survivors.
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Affiliation(s)
- Ewa Rajpert-De Meyts
- Department of Growth and Reproduction, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disrupting Effects on Male Reproduction and Child Health, Copenhagen, Denmark
| | - Katherine A McGlynn
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Keisei Okamoto
- Department of Urology, Shiga University of Medical Science, Tsukinowa, Seta, Shiga, Japan.
| | - Michael A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Carsten Bokemeyer
- Department of Oncology, Haematology, Bone Marrow Transplantation with section Pneumology, Department of Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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