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Vaghari-Tabari M, Jafari-Gharabaghlou D, Mohammadi M, Hashemzadeh MS. Zinc Oxide Nanoparticles and Cancer Chemotherapy: Helpful Tools for Enhancing Chemo-sensitivity and Reducing Side Effects? Biol Trace Elem Res 2024; 202:1878-1900. [PMID: 37639166 DOI: 10.1007/s12011-023-03803-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/05/2023] [Indexed: 08/29/2023]
Abstract
Cancer chemotherapy is still a serious challenge. Chemo-resistance and destructive side effects of chemotherapy drugs are the most critical limitations of chemotherapy. Chemo-resistance is the leading cause of chemotherapy failure. Chemo-resistance, which refers to the resistance of cancer cells to the anticancer effects of chemotherapy drugs, is caused by various reasons. Among the most important of these reasons is the increase in the efflux of chemotherapy drugs due to the rise in the expression and activity of ABC transporters, the weakening of apoptosis, and the strengthening of stemness. In the last decade, a significant number of studies focused on the application of nanotechnology in cancer treatment. Considering the anti-cancer properties of zinc, zinc oxide nanoparticles have received much attention in recent years. Some studies have indicated that zinc oxide nanoparticles can target the critical mechanisms of cancer chemo-resistance and enhance the effectiveness of chemotherapy drugs. These studies have shown that zinc oxide nanoparticles can reduce the activity of ABC transporters, increase DNA damage and apoptosis, and attenuate stemness in cancer cells, leading to enhanced chemo-sensitivity. Some other studies have also shown that zinc oxide nanoparticles in low doses can be helpful in minimizing the harmful side effects of chemotherapy drugs. In this article, after a brief overview of the mechanisms of chemo-resistance and anticancer effects of zinc, we will review all these studies in detail.
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Affiliation(s)
- Mostafa Vaghari-Tabari
- Nanobiotechnology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Davoud Jafari-Gharabaghlou
- Department of Clinical Biochemistry and Laboratory Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mozafar Mohammadi
- Applied Biotechnology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Hafey MJ, Aleksunes LM, Bridges CC, Brouwer KR, Chien HC, Leslie EM, Hu S, Li Y, Shen J, Sparreboom A, Sprowl J, Tweedie D, Lai Y. Transporters and Toxicity: Insights from the International Transporter Consortium Workshop 4. Clin Pharmacol Ther 2022; 112:527-539. [PMID: 35546260 DOI: 10.1002/cpt.2638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/30/2022] [Indexed: 12/29/2022]
Abstract
Over the last decade, significant progress been made in elucidating the role of membrane transporters in altering drug disposition, with important toxicological consequences due to changes in localized concentrations of compounds. The topic of "Transporters and Toxicity" was recently highlighted as a scientific session at the International Transporter Consortium (ITC) Workshop 4 in 2021. The current white paper is not intended to be an extensive review on the topic of transporters and toxicity but an opportunity to highlight aspects of the role of transporters in various toxicities with clinically relevant implications as covered during the session. This includes a review of the role of solute carrier transporters in anticancer drug-induced organ injury, transporters as key players in organ barrier function, and the role of transporters in metal/metalloid toxicity.
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Affiliation(s)
- Michael J Hafey
- ADME and Discovery Toxicology, Merck & Co., Inc., Rahway, New Jersey, USA
| | - Lauren M Aleksunes
- Department of Pharmacology and Toxicology, Rutgers University, Piscataway, New Jersey, USA
| | - Christy C Bridges
- Department of Biomedical Sciences, Mercer University School of Medicine, Macon, Georgia, USA
| | | | - Huan-Chieh Chien
- Pharmacokinetics and Drug Metabolism, Amgen, Inc., South San Francisco, California, USA
| | - Elaine M Leslie
- Departments of Physiology and Lab Med and Path, Membrane Protein Disease Research Group, University of Alberta, Edmonton, Alberta, Canada
| | - Shuiying Hu
- Division of Outcomes and Translational Sciences, College of Pharmacy, The Ohio State University, Columbus, Ohio, USA
| | - Yang Li
- Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, Columbus, Ohio, USA
| | - Jinshan Shen
- Relay Therapeutics, Cambridge, Massachusetts, USA
| | - Alex Sparreboom
- Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, Columbus, Ohio, USA
| | - Jason Sprowl
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, New York, USA
| | | | - Yurong Lai
- Drug Metabolism, Gilead Sciences Inc., Foster City, California, USA
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Primary Ovarian Choriocarcinoma: Rare Entity. Case Rep Obstet Gynecol 2021; 2021:4545375. [PMID: 34608421 PMCID: PMC8487380 DOI: 10.1155/2021/4545375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/13/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
Background Primary pure ovarian choriocarcinoma is a rare aggressive tumor which can be nongestational arising from germ cells or gestational origin. Preoperative diagnosis of extrauterine choriocarcinoma is challenging due to nonspecific clinical presentation. Case Presentation. This article reports primary ovarian choriocarcinoma, likely gestational in a 25-year-old para 2 woman presenting with lower abdominal pain and swelling of two-week duration. Diagnosis was suspected by serum beta-human chorionic gonadotropin and confirmed histologically after surgery. Postoperatively, she was managed with multiple courses of chemotherapy using a bleomycin, etoposide, and cisplatin regimen, and the treatment was effective. Conclusion In patients with adnexal mass presenting with nonspecific symptoms especially with high Doppler blood flow of the mass on ultrasound evaluation, serum beta-human chorionic gonadotropin determination is recommended before laparotomy. In setups where the genomic test is not available, histological and clinical effort to differentiate gestational versus nongestational choriocarcinoma is useful for specific management decision.
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Cancer survivorship: Reproductive health outcomes should be included in standard toxicity assessments. Eur J Cancer 2021; 144:310-316. [DOI: 10.1016/j.ejca.2020.11.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/17/2020] [Accepted: 11/24/2020] [Indexed: 12/13/2022]
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Gerstl B, Bertoldo MJ, Sullivan E, Volckmar X, Kerr A, Wand H, Ives A, Albalawi O, Anazodo A. Fatherhood Following Treatment for Testicular Cancer: A Systematic Review and Meta-Analyses. J Adolesc Young Adult Oncol 2020; 9:341-353. [DOI: 10.1089/jayao.2019.0164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brigitte Gerstl
- Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia
- Kids Cancer Center, Sydney Children's Hospital, Sydney, Australia
| | - Michael J. Bertoldo
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Elizabeth Sullivan
- Faculty Health and Medicine, The University of Newcastle, Newcastle, Australia
| | - Xanthie Volckmar
- Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Aidan Kerr
- Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Handan Wand
- Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Angela Ives
- Cancer and Palliative Care Research and Evaluation Unit, University of Western Australia, Crawley, Australia
| | - Olayan Albalawi
- Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia
- Department of Statistics, Science College, Tabuk University, Tabuk, Saudi Arabia
| | - Antoinette Anazodo
- Kids Cancer Center, Sydney Children's Hospital, Sydney, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
- Nelune Comprehensive Cancer Center, Prince of Wales Hospital, Sydney, Australia
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Rabaça A, Ferreira C, Bernardino R, Alves M, Oliveira P, Viana P, Barros A, Sousa M, Sá R. Use of antioxidant could ameliorate the negative impact of etoposide on human sperm DNA during chemotherapy. Reprod Biomed Online 2020; 40:856-866. [PMID: 32376314 DOI: 10.1016/j.rbmo.2020.01.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 12/31/2019] [Accepted: 01/30/2020] [Indexed: 01/07/2023]
Abstract
RESEARCH QUESTION A previous study showed that N-acetylcysteine (NAC), used after in-vitro exposure to the gonadotoxic chemotherapeutic drug etoposide, has the ability to decrease DNA damage in human spermatozoa; however, it showed no benefit when used before exposure. This study aimed to evaluate the impact of the NAC on the preservation of sperm quality during in-vitro exposure to etoposide. DESIGN Twenty semen samples were submitted to four experimental conditions: control, NAC-only incubation, etoposide-only incubation, and concomitant etoposide and NAC incubation. After in-vitro incubation, semen parameters, sperm chromatin condensation, sperm DNA fragmentation, sperm oxidative stress and sperm metabolism were used to evaluate the role of NAC in protecting human spermatozoa from etoposide. RESULTS Etoposide did not affect semen parameters, nor did it cause sperm oxidative damage or alterations in glycolytic profile. However, it induced chromatin decondensation and DNA fragmentation, which were fully prevented by NAC. CONCLUSIONS NAC was able to protect sperm DNA integrity during etoposide treatment in vitro, suggesting that NAC may be useful as an adjuvant agent in preserving male fertility during chemotherapy treatments.
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Affiliation(s)
- Ana Rabaça
- Laboratory of Cell Biology, Department of Microscopy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto (UP), Porto, Portugal
| | - Carolina Ferreira
- Laboratory of Cell Biology, Department of Microscopy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto (UP), Porto, Portugal
| | - Raquel Bernardino
- Laboratory of Cell Biology, Department of Microscopy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto (UP), Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal
| | - Marco Alves
- Laboratory of Cell Biology, Department of Microscopy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto (UP), Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal
| | - Pedro Oliveira
- Laboratory of Cell Biology, Department of Microscopy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto (UP), Porto, Portugal; Department of Genetics, Faculty of Medicine, University of Porto, Porto, Portugal; Health Institute of Research and Innovation (IPATIMUP/i3S), University of Porto, Porto, Portugal
| | - Paulo Viana
- Centre for Reproductive Genetics A. Barros (CGR), Porto, Portugal
| | - Alberto Barros
- Department of Genetics, Faculty of Medicine, University of Porto, Porto, Portugal; Health Institute of Research and Innovation (IPATIMUP/i3S), University of Porto, Porto, Portugal; Centre for Reproductive Genetics A. Barros (CGR), Porto, Portugal
| | - Mário Sousa
- Laboratory of Cell Biology, Department of Microscopy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto (UP), Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal.
| | - Rosália Sá
- Laboratory of Cell Biology, Department of Microscopy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto (UP), Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal
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Baetas J, Rabaça A, Gonçalves A, Barros A, Sousa M, Sá R. Protective role of N-acetylcysteine (NAC) on human sperm exposed to etoposide. Basic Clin Androl 2019; 29:3. [PMID: 30774957 PMCID: PMC6366041 DOI: 10.1186/s12610-018-0082-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/28/2018] [Indexed: 01/02/2023] Open
Abstract
Background Although recent progress in cancer treatment has increased patient survival and improved quality of life, reproductive side effects are still for concern. One way to decrease gonadal impairment is to use cytoprotectors. In testicular cancer, etoposide is generally used in combination with other agents, but there are no in-vitro studies of sperm exposure to etoposide and cytoprotectors, namely N-acetylcysteine (NAC). Methods Twenty semen samples were individually divided into five groups: control, incubation with NAC alone, incubation with etoposide alone, sequential exposure of NAC followed by etoposide (pre-treatment) and sequential exposure of etoposide followed by NAC (post-treatment). Sperm characteristics, chromatin condensation (aniline blue), DNA fragmentation (TUNEL), oxidative stress (OxyDNA labelling) and glutathione quantification were used to evaluate the capabilities of NAC as a prophylactic (pre-treatment) or ameliorator (post-treatment) agent over the effects caused in sperm during in-vitro exposure to etoposide. Results No deleterious effects were observed on sperm motility or sperm membrane integrity. Results revealed that prophylactic use of NAC (pre-treatment) increased rates of immature sperm chromatin as compared to ameliorator use of NAC (post-treatment), and increased rates of sperm DNA fragmentation in relation to controls. Pre and post-treatment with NAC increased oxidative levels in comparison to controls, but also increased levels of cellular antioxidant glutathione. Conclusions The results indicate that NAC has the ability to counteract etoposide-induced toxicity rather than preventing the etoposide cytotoxic effects over sperm DNA, suggesting that the administration of NAC to cells formerly exposed to etoposide is preferable to its prophylactic use. As the results evidenced that NAC seems to be more efficient in attenuating sperm etoposide cytotoxic effects instead of being used as a chemoprophylactic agent, this reinforces the idea that there might be a new NAC mechanism over DNA.
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Affiliation(s)
- João Baetas
- 1Laboratory of Cell Biology, Department of Microscopy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto (UP), Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal.,2Faculty of Sciences, University of Porto, 4169-007 Porto, Portugal
| | - Ana Rabaça
- 1Laboratory of Cell Biology, Department of Microscopy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto (UP), Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
| | - Ana Gonçalves
- Centre for Reproductive Genetics A. Barros (CGR), Av. do Bessa, 240, 1° Dto. Frente, 4100-012 Porto, Portugal
| | - Alberto Barros
- Centre for Reproductive Genetics A. Barros (CGR), Av. do Bessa, 240, 1° Dto. Frente, 4100-012 Porto, Portugal.,4Department of Genetics, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.,5Health Institute of Research and Innovation (IPATIMUP/i3S), University of Porto, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal
| | - Mário Sousa
- 1Laboratory of Cell Biology, Department of Microscopy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto (UP), Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal.,6Multidisciplinary Unit for Biomedical Research (UMIB), University of Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
| | - Rosália Sá
- 1Laboratory of Cell Biology, Department of Microscopy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto (UP), Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal.,6Multidisciplinary Unit for Biomedical Research (UMIB), University of Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
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Kawai K, Nishiyama H. Preservation of fertility of adult male cancer patients treated with chemotherapy. Int J Clin Oncol 2018; 24:34-40. [PMID: 30353257 DOI: 10.1007/s10147-018-1333-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 07/28/2018] [Indexed: 01/09/2023]
Abstract
Chemotherapy-induced gonadal dysfunction resulting in transient or persistent infertility depends on the type of drugs and cumulative dose, and it is an important long-term complication, especially for adolescent and young adult (AYA) cancer patients. Due to its importance, a clinical practice guideline for fertility preservation in childhood and AYA cancer patients was published by the Japan Society of Clinical Oncology (JSCO) in 2017. Although the precise mechanisms remain unclear, several studies reported that the cancer itself, not the cancer treatment, adversely affected semen quality. It is reported that that poor pretreatment semen quality is commonly seen in various cancer types including testicular cancer, leukemia, brain tumor, and sarcoma. Fortunately, however, even men with poor sperm quality can be candidates for sperm cryopreservation due to recent advances in assisted reproductive technology (ART) and sperm banking techniques. Therefore, the JSCO guideline and others recommend that sperm cryopreservation should be considered as early as possible when patients are planning to undergo treatment that may render them infertile. The previous studies showed that testicular cancer and hematological tumors are the two leading types of cancer among patients who requested sperm cryopreservation. This is followed by bone and soft-tissue tumors and central nervous system tumors and others. Although the efficacy of postchemotherapy testicular sperm extraction (TESE)/intracytoplasmic sperm injection (ICSI) was reported recently, it is quite important to inform patients of the potential risk of treatment-induced infertility and the possibility of fertility preservation by sperm cryopreservation before chemotherapy.
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Affiliation(s)
- Koji Kawai
- Department of Urology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Hiroyuki Nishiyama
- Department of Urology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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Fertility preservation for men with testicular cancer: Is sperm cryopreservation cost effective in the era of assisted reproductive technology? Urol Oncol 2018; 36:92.e1-92.e9. [DOI: 10.1016/j.urolonc.2017.11.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/27/2017] [Accepted: 11/06/2017] [Indexed: 12/20/2022]
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Maroto P, Anguera G, Martin C. Long-term toxicity of the treatment for germ cell-cancer. A review. Crit Rev Oncol Hematol 2018; 121:62-67. [DOI: 10.1016/j.critrevonc.2017.11.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 11/07/2017] [Accepted: 11/20/2017] [Indexed: 12/18/2022] Open
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Identification of sperm mRNA biomarkers associated with testis injury during preclinical testing of pharmaceutical compounds. Toxicol Appl Pharmacol 2017; 320:1-7. [PMID: 28167222 DOI: 10.1016/j.taap.2017.02.001] [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: 08/25/2016] [Revised: 01/03/2017] [Accepted: 02/03/2017] [Indexed: 12/30/2022]
Abstract
The human testis is sensitive to toxicant-induced injury but current methods for detecting adverse effects are limited, insensitive and unreliable. Animal studies use sensitive histopathological endpoints to assess toxicity, but require testicular tissue that is not available during human clinical trials. More sensitive and reliable molecular biomarkers of testicular injury are needed to better monitor testicular toxicity in both clinical and preclinical. Adult male Wistar Han rats were exposed for 4weeks to compounds previously associated with testicular injury, including cisplatin (0, 0.2, 0.3, or 0.4mg/kg/day), BI665915 (0, 20, 70, 100mg/kg/d), BI665636 (0, 20, 100mg/kg/d) or BI163538 (0, 70, 150, 300mg/kg/d) to evaluate reproductive toxicity and assess changes in sperm mRNA levels. None of the compounds resulted in any significant changes in body, testis or epididymis weights, nor were there decreases in testicular homogenization resistant spermatid head counts. Histopathological evaluation found that only BI665915 treatment caused any testicular effects, including minor germ cell loss and disorganization of the seminiferous tubule epithelium, and an increase in the number of retained spermatid heads. A custom PCR-array panel was used to assess induced changes in sperm mRNA. BI665915 treatment resulted in a significant increase in clusterin (Clu) levels and decreases in GTPase, IMAP family member 4 (Gimap4), prostaglandin D2 synthase (Ptgds) and transmembrane protein with EGF like and two follistatin like domains 1 (Tmeff1) levels. Correlation analysis between transcript levels and quantitative histopathological endpoints found a modest association between Clu with retained spermatid heads. These results demonstrate that sperm mRNA levels are sensitive molecular indicators of testicular injury that can potentially be translated into a clinical setting.
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Utilization of sperm banking and barriers to its use in testicular cancer patients. Support Care Cancer 2015; 23:2763-8. [PMID: 25680764 DOI: 10.1007/s00520-015-2641-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/28/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE Testicular cancer is the most common carcinoma in 20- to 40-year-old men. Eighty percent of patients with metastases achieve disease-free status with chemotherapy with or without surgical resection. Standard first-line chemotherapy is bleomycin, etoposide, and cisplatin (BEP) for three to four courses or etoposide and cisplatin (EP) for four courses. Forty percent of patients receiving chemotherapy will have permanently reduced sperm counts impairing future fertility. Sperm banking is an effective method of maintaining fertility. This retrospective study was performed to assess utilization and results from sperm banking, as well as the barriers to its use. METHODS Patients 18 and older who had received chemotherapy were given a five-item questionnaire on follow-up visit. This questionnaire included a mix of quantitative and qualitative questions. RESULTS Two hundred patients enrolled in the study, and all 200 completed the questionnaire. Of the two hundred, 139 (70 %) patients chose not to bank sperm; 71 (51 %) of those were not interested, 25 (18 %) declined due to desire to start chemotherapy, 24 (17 %) were not offered, 12 (9 %) declined due to cost, and 7 (5 %) answered "other." The average age at cancer diagnosis of patients who banked sperm was 28.4 as opposed to 32.6 for patients who did not (p = 0.003). The percentage of patients that had children before their diagnosis was 21 % in the sperm banking group, and 50 % in the group that did not (p = 0.0002). Sixty-one (30 %) chose to bank sperm; 11 of 61 patients (18 %) utilized the banked sperm; 9 of 11 (82 %) patients that utilized were successful; and 3 of 9 (33 %) successes resulted in multiple gestations. CONCLUSIONS Sperm banking provides the opportunity for paternity in testicular cancer patients with reduced sperm counts following treatment. However, the majority of these patients chose not to bank sperm or were not offered the opportunity. A range of factors such as time, emotional state, patient age, disease stage, prior children, institutional practices, and cost all influence whether banking is offered to patients and taken up. The authors provide recommendations to help clinicians overcome some of these barriers.
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Pan BS, Wang YK, Lai MS, Mu YF, Huang BM. Cordycepin induced MA-10 mouse Leydig tumor cell apoptosis by regulating p38 MAPKs and PI3K/AKT signaling pathways. Sci Rep 2015; 5:13372. [PMID: 26303320 PMCID: PMC4548195 DOI: 10.1038/srep13372] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 07/24/2015] [Indexed: 01/07/2023] Open
Abstract
The p38 MAPKs play important roles in the regulation of balance between cell survival and cell death on the development of various cancers. However, the roles of p38 MAPKs regulating apoptotic effects on Leydig tumor cells remain unclear. In the present study, we showed that cordycepin (3′-deoxyadenosine) selectively induced apoptosis in MA-10 mouse Leydig tumor cells through regulating the p38 MAPK and PI3K/AKT signaling pathways. Cordycepin reduced viability in MA-10, TM4, and NT2/D1 cells, but not cause cell death of primary mouse Leydig cells on moderate concentration. Cordycepin increased reactive oxygen species (ROS) levels, which is associated with the induction of apoptosis as characterized by positive Annexin V binding, activation of caspase-3, and cleavage of PARP. Inhibition of p38 MAPKs activity by SB203580 significantly prevented cordycepin-induced apoptosis in MA-10 cells. Co-treatment with wortmannin or the autophagy inhibitor 3-methyladenine (3-MA) elevated levels of apoptosis in cordycepin-treated MA-10 cells. Moreover, cordycepin activated p53, p21 and TGFß; and downregulated CDK2. The antitumour activity of cordycepin-treated MA-10 cells was significantly distinct in severe combined immunodeficiency (SCID) mice in vivo. These results suggested that cordycein is a highly selective treatment to induce MA-10 cells apoptosis via p38 MAPKs signaling.
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Affiliation(s)
- Bo-Syong Pan
- Institute of Basic Medical Sciences, College of Medicine, National Chen Kung University, Tainan, Taiwan, Republic of China.,Department of Cell Biology and Anatomy, College of Medicine, National Chen Kung University, Tainan, Taiwan, Republic of China
| | - Yang-Kao Wang
- Institute of Basic Medical Sciences, College of Medicine, National Chen Kung University, Tainan, Taiwan, Republic of China.,Department of Cell Biology and Anatomy, College of Medicine, National Chen Kung University, Tainan, Taiwan, Republic of China
| | - Meng-Shao Lai
- Institute of Basic Medical Sciences, College of Medicine, National Chen Kung University, Tainan, Taiwan, Republic of China.,Department of Cell Biology and Anatomy, College of Medicine, National Chen Kung University, Tainan, Taiwan, Republic of China
| | - Yi-Fen Mu
- Department of Cell Biology and Anatomy, College of Medicine, National Chen Kung University, Tainan, Taiwan, Republic of China
| | - Bu-Miin Huang
- Institute of Basic Medical Sciences, College of Medicine, National Chen Kung University, Tainan, Taiwan, Republic of China.,Department of Cell Biology and Anatomy, College of Medicine, National Chen Kung University, Tainan, Taiwan, Republic of China
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Whirledge SD, Garcia JM, Smith RG, Lamb DJ. Ghrelin partially protects against cisplatin-induced male murine gonadal toxicity in a GHSR-1a-dependent manner. Biol Reprod 2015; 92:76. [PMID: 25631345 DOI: 10.1095/biolreprod.114.123570] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The chemotherapeutic drug cisplatin causes a number of dose-dependent side effects, including cachexia and testicular damage. Patients receiving a high cumulative dose of cisplatin may develop permanent azoospermia and subsequent infertility. Thus, the development of chemotherapeutic regimens with the optimal postsurvival quality of life (fertility) is of high importance. This study tested the hypothesis that ghrelin administration can prevent or minimize cisplatin-induced testicular damage and cachexia. Ghrelin and its receptor, the growth hormone secretagogue receptor (GHSR-1a), are expressed and function in the testis. Targeted deletion of ghrelin, or its receptor, significantly increases the rate of cell death in the testis, suggesting a protective role. Intraperitoneal administration of vehicle, ghrelin, or cisplatin alone or in combination with ghrelin, in cycles of 9 or 18 days, to adult male C57Bl/6 mice was performed. Body weight was measured daily and testicular and epididymal weight, sperm density and motility, testicular histology, and testicular cell death were analyzed at the time of euthanization. Ghrelin coadministration decreased the severity of cisplatin-induced cachexia and gonadal toxicity. Body, testicular, and epididymal weights significantly increased as testicular cell death decreased with ghrelin coadministration. The widespread damage to the seminiferous epithelium induced by cisplatin administration was less severe in mice simultaneously treated with ghrelin. Furthermore, ghrelin diminished the deleterious effects of cisplatin on testis and body weight homeostasis in wild-type but not Ghsr(-/-) mice, showing that ghrelin's actions are mediated via GHSR. Ghrelin or more stable GHSR agonists potentially offer a novel therapeutic approach to minimize the testicular damage that occurs after gonadotoxin exposure.
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Affiliation(s)
- Shannon D Whirledge
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas
| | - Jose M Garcia
- Division of Endocrinology, Diabetes, and Metabolism, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, Texas
| | - Roy G Smith
- Department of Metabolism and Aging, The Scripps Research Institute, Jupiter, Florida
| | - Dolores J Lamb
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas Scott Department of Urology, Baylor College of Medicine, Houston, Texas Center for Reproductive Medicine, Baylor College of Medicine, Houston, Texas
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Primary ovarian choriocarcinoma mimicking ectopic pregnancy. Obstet Gynecol Sci 2014; 57:330-3. [PMID: 25105109 PMCID: PMC4124097 DOI: 10.5468/ogs.2014.57.4.330] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 12/22/2013] [Accepted: 01/03/2014] [Indexed: 11/08/2022] Open
Abstract
Nongestational ovarian choriocarcinoma is an exceedingly rare and highly aggressive tumor. Although early diagnosis and timely initiation of therapy is important, it is difficult in reproductive aged patients because of the frequent elevation of human chorionic gonadotropin. We report a primarily nongestational ovarian choriocarcinoma in a 12-year-old virgin female. Initial diagnosis based on abdominopelvic computed tomography and pelvis magnetic resonance imaging was ectopic pregnancy with hemoperitoneum. A diagnostic laparoscopy of the ovarian tumor revealed choriocarcinoma. Unilateral salpingo-oophorectomy and omental sampling revealed surgical stage of IA. Six courses of adjuvant combination chemotherapy (bleomycin, etoposide, and cisplatin) followed surgery.
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16
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Anand H, Misro MM, Sharma SB, Prakash S. Protective effects of Eugenia jambolana extract versus N-acetyl cysteine against cisplatin-induced damage in rat testis. Andrologia 2014; 47:194-208. [PMID: 24576220 DOI: 10.1111/and.12247] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2013] [Indexed: 11/27/2022] Open
Abstract
To assess the protective effects of Eugenia jambolana extract (EJE) or N-acetyl cysteine (NAC) on testis, cisplatin (CIS, 5 mg kg(-1) bw, single dose) was administered either alone or along with EJE (25 mg kg(-1) bw, alternate day) or NAC (150 mg kg(-1) bw, Day 1 and 4) for 7 days. Significant alterations in serum LH, FSH and testosterone were observed in CIS group which were effectively modulated by EJE or NAC supplementation. Upregulation of 3β-HSD gene indicated the rise in functional Leydig cells. This was further confirmed from the identical improvement in hCG-stimulated testosterone production in isolated Leydig cells. Reduction in oxidative stress was associated with restoration of total antioxidant capacity and glutathione levels, and activation of antioxidant enzymes, SOD, catalase, glutathione s-transferase (GST) and glutathione reductase (GR). CIS-induced apoptosis of germ and Leydig cells was contained by both NAC and EJE intervention by effective modulation of apoptotic markers in the extrinsic, intrinsic and other pathways of metazoan apoptosis. Taken together, the study findings establish the potential of EJE as a therapeutically better antioxidant than NAC for use in curtailing the adverse effects of anticancer drugs on testicular function.
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Affiliation(s)
- H Anand
- Department of Reproductive Biomedicine, National Institute of Health and Family Welfare, Baba Gang Nath Marg, Munirka, New Delhi, India; Department of Zoology, Dayalbagh Educational Institute, Agra, India
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17
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Dunning NL, Laversin SA, Miles AK, Rees RC. Immunotherapy of prostate cancer: should we be targeting stem cells and EMT? Cancer Immunol Immunother 2011; 60:1181-93. [PMID: 21688178 PMCID: PMC11029142 DOI: 10.1007/s00262-011-1065-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 06/07/2011] [Indexed: 12/31/2022]
Abstract
Cancer stem cells have been implicated in a number of solid malignancies including prostate cancer. In the case of localised prostate cancer, patients are often treated with surgery (radical prostatectomy) and/or radiotherapy. However, disease recurrence is an issue in about 30% of patients, who will then go on to receive hormone ablation therapy. Hormone ablation therapy is often palliative in a vast proportion of individuals, and for hormone-refractory patients, there are several immunotherapies targeting a number of prostate tumour antigens which are currently in development. However, clinical responses in this setting are inconsistent, and it is believed that the failure to achieve full and permanent tumour eradication is due to a small, resistant population of cells known as 'cancer stem cells' (CSCs). The stochastic and clonal evolution models are among several models used to describe cancer development. The general consensus is that cancer may arise in any cell as a result of genetic mutations in oncogenes and tumour suppressor genes, which consequently result in uncontrolled cell growth. The cancer stem cell theory, however, challenges previous opinion and proposes that like normal tissues, tumours are hierarchical and only the rare subpopulation of cells at the top of the hierarchy possess the biological properties required to initiate tumourigenesis. Furthermore, where most cancer models infer that every cell within a tumour is equally malignant, i.e. equally capable of reconstituting new tumours, the cancer stem cell theory suggests that only the rare cancer stem cell component possess tumour-initiating capabilities. Hence, according to this model, cancer stem cells are implicated in both tumour initiation and progression. In recent years, the role of epithelial--mesenchymal transition (EMT) in the advancement of prostate cancer has become apparent. Therefore, CSCs and EMT are both likely to play critical roles in prostate cancer tumourigenesis. This review summarises the current immunotherapeutic strategies targeting prostate tumour antigens taking into account the need to consider treatments that target cancer stem cells and cells involved in epithelial--mesenchymal transition.
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Affiliation(s)
- Naomi L. Dunning
- The John van Geest Cancer Research Centre, Nottingham Trent University, School of Science and Technology, Clifton Campus, Nottingham, NG11 8NS UK
| | - Stéphanie A. Laversin
- The John van Geest Cancer Research Centre, Nottingham Trent University, School of Science and Technology, Clifton Campus, Nottingham, NG11 8NS UK
| | - Amanda K. Miles
- The John van Geest Cancer Research Centre, Nottingham Trent University, School of Science and Technology, Clifton Campus, Nottingham, NG11 8NS UK
| | - Robert C. Rees
- The John van Geest Cancer Research Centre, Nottingham Trent University, School of Science and Technology, Clifton Campus, Nottingham, NG11 8NS UK
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Yeap ST, Hsiao CC, Hsieh CS, Yu HR, Chen YC, Chuang JH, Sheen JM. Pediatric malignant ovarian tumors: 15 years of experience at a single institution. Pediatr Neonatol 2011; 52:140-4. [PMID: 21703555 DOI: 10.1016/j.pedneo.2011.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 06/11/2010] [Accepted: 07/13/2010] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Malignant ovarian tumors in children are relatively rare. We reviewed our 15-year experience to understand their clinical presentations, managements, and prognoses. METHODS There were 15 children who were diagnosed to have malignant ovarian tumors from January 1994 to June 2009 in our hospital. The presenting symptoms, treatments, and outcomes were obtained retrospectively from the medical records. RESULTS The median age at presentation was 13 years. The most common presenting symptom was abdominal pain, occurring in 10 patients (66.7%). The tumors were in the left side in 10 patients (66.7%). The pathologic diagnoses were yolk sac tumors in four patients, immature teratomas in four, dysgerminomas in three, malignant mixed germ cell tumors in three, and carcinosarcoma in one patient. According to the Federation Internationale de Gynecologie Oncologique classification, seven girls had Stage I, one had Stage II, and seven had Stage III disease. Thirteen patients received chemotherapy with platinum-based regimens. Three patients died of their disease: one of yolk sac tumor, one of malignant mixed germ cell tumor, and one of carcinosarcoma. They all had Stage III disease at diagnosis. The 10-year overall survival and disease-free survival rates were 77% and 69%, respectively. CONCLUSIONS Pediatric malignant ovarian tumors were highly curable disease if they were not in the advanced stage at presentation. Earlier consideration of malignant ovarian tumor in the differential diagnosis of young girls with abdominal pain is important.
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Affiliation(s)
- Say-Tin Yeap
- Department of Pediatrics, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Paternity and Testicular Function Among Testicular Cancer Survivors Treated With Two to Four Cycles of Cisplatin-Based Chemotherapy. Eur Urol 2010; 58:134-40. [DOI: 10.1016/j.eururo.2010.03.041] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 03/24/2010] [Indexed: 11/19/2022]
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Kong B, Tian YJ, Zhu WW, Qin YJ. A pure nongestational ovarian choriocarcinoma in a 10-year-old girl: Case report and literature review. J Obstet Gynaecol Res 2009; 35:574-8. [DOI: 10.1111/j.1447-0756.2008.00973.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ortiz RJ, Lizama C, Codelia VA, Moreno RD. A molecular evaluation of germ cell death induced by etoposide in pubertal rat testes. Mol Hum Reprod 2009; 15:363-71. [PMID: 19346530 DOI: 10.1093/molehr/gap024] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Etoposide is widely used in the treatment of patients with testicular cancer. The mechanism underlying apoptosis induction in cancer cells has been studied in different cell types, but it is not known whether the same factors participate in viable germ cells undergoing programmed cell death. Since testicular cancer primarily affects young males, we used pubertal rats (21 days old) as a model to determine different apoptotic parameters after etoposide treatment in healthy testes. We found that one intratesticular injection of etoposide (1.2 microg/testis) induced a significant increase in spermatocytes undergoing apoptosis, along with activation of caspase-9, -8 and -3 after 24 h of treatment. Spermatocyte apoptosis was inhibited when a general caspase inhibitor was added along with etoposide. Etoposide induces a significant stabilization/activation of p53, resulting in an increase level of this protein. The mRNA of Bcl-2 antagonist of cell death (BAD), a pro-apoptotic gene and a transcriptional target of p53, was significantly increased after etoposide treatment. Thus, our results suggest a single injection of etoposide induces apoptosis in healthy pachytene spermatocytes mediated by p53 and caspase activation. These findings will assist the search for new therapies to prevent the deleterious effect of cancer drugs upon normal cells.
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Affiliation(s)
- Rina J Ortiz
- Departamento de Ciencias Fisiológicas, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Alameda 340, Santiago, Chile
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Delbès G, Chan D, Pakarinen P, Trasler JM, Hales BF, Robaire B. Impact of the chemotherapy cocktail used to treat testicular cancer on the gene expression profile of germ cells from male Brown-Norway rats. Biol Reprod 2008; 80:320-7. [PMID: 18987330 DOI: 10.1095/biolreprod.108.072108] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Advances in treatment for testicular cancer that include the coadministration of bleomycin, etoposide, and cisplatin (BEP) have brought the cure rate to higher than 90%%. The goal of this study was to elucidate the impact of BEP treatment on gene expression in male germ cells. Brown-Norway rats were treated for 9 wk with vehicle (0x) or BEP at doses equivalent to 0.3x and 0.6x the human dose. At the end of treatment, spermatogenesis was affected, showing altered histology and a decreased sperm count; spermatozoa had a higher number of DNA breaks. After 9 wk of treatment, round spermatids were isolated, and RNA was extracted and probed on Rat230-2.0 Affymetrix arrays. Of the 31 099 probe sets present on the array, 59%% were expressed in control round spermatids. BEP treatment significantly altered the expression of 221 probe sets, with at least a 1.5-fold change compared with controls; 80% were upregulated. We observed a dose-dependent increase in the expression of oxidative stress response genes and no change in the expression of genes involved in DNA repair. BEP upregulated genes were implicated in pathways related to Jun and Junb protooncogenes. Increased mRNA levels of Jun and Junb were confirmed by quantitative RT-PCR; furthermore, JUN protein was increased in elongating spermatids. Thus, BEP exposure triggers an oxidative stress response in round spermatids and induces many pathways that may lead to the survival of damaged cells and production of abnormal sperm.
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Affiliation(s)
- Geraldine Delbès
- Department of Pharmacology and Therapeutics, McGill University, Montreal Children's Hospital Research Institute, Montréal, Québec, Canada H3G 1Y6
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23
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Management of advanced germ-cell tumors of the testis. ACTA ACUST UNITED AC 2008; 5:262-76. [DOI: 10.1038/ncpuro1101] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Accepted: 02/15/2008] [Indexed: 11/08/2022]
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24
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Fosså SD, Travis LB, Dahl AA. Medical and Psychosocial Issues in Testicular Cancer Survivors. Oncology 2007. [DOI: 10.1007/0-387-31056-8_104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Testicular cancer is the most common solid organ tumor in young men and affects men during their reproductive years. Current therapeutic regimens have significantly improved survival but often adversely impact fertility. Understanding the effects of testicular cancer, the systemic effects of neoplasia, and the effects of treatment protocols, such as radiotherapy, chemotherapy, and retroperitoneal lymph node dissection, is essential to restoring and maintaining fertility in men who have germ cell neoplasms.
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Affiliation(s)
- Sarah M Lambert
- Male Reproductive Center, Department of Urology, Columbia University, College of Physicians and Surgeons, New York Presbyterian Hospital, 944 Park Avenue, New York, NY 10028, USA
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26
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Borovskaya TG, Gol'dberg VE, Shchemerova YA, Perova AV, Timina EA, Pakhomova AV. Evaluation of the progeny of rats treated with topoisomerase II inhibitor vepesid. Bull Exp Biol Med 2006; 141:578-80. [PMID: 17181057 DOI: 10.1007/s10517-006-0225-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Progeny of Wistar rats treated with vepesid 1, 3, and 6 months before mating is characterized by common pathological changes. These changes were more pronounced and more diverse in animals descending from females receiving the cytostatic compared to the progeny of treated males. The severity of toxic effects depended on the period between mating and vepesid treatment. Cytostatic treatment 3 months before mating was associated with minimum toxicity for the progeny.
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Affiliation(s)
- T G Borovskaya
- Institute of Pharmacology, Tomsk Research Center, Siberian Division, Russian Academy of Medical Sciences.
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27
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Steiner H, Müller T, Gozzi C, Akkad T, Bartsch G, Berger AP. Two cycles of cisplatin-based chemotherapy for low-volume retroperitoneal stage II nonseminomatous germ cell tumours. BJU Int 2006; 98:349-52. [PMID: 16626306 DOI: 10.1111/j.1464-410x.2006.06218.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the oncological efficacy of reducing cisplatin-based chemotherapy to two cycles in patients with low-volume retroperitoneal stage II nonseminomatous germ cell tumours (NSGCTs). PATIENTS AND METHODS From October 1988 until January 2004, two cycles of cisplatin-based chemotherapy were administered in 59 patients with low-volume retroperitoneal clinical stage II NSGCT (retroperitoneal mass of <5 cm in diameter). Regardless of remission detected on computed tomography, 6 weeks after chemotherapy the patients had a retroperitoneal lymph node dissection (RPLND) to assess residual active tumour or mature teratoma (open modified bilateral RPLND until 1992, then laparoscopic unilateral template RPLND). RESULTS The chemotherapy was effective, as no active tumour was found in any of RPLND specimens. Mature teratoma was present in lymphatic tissue in 23 of 59 patients (39%). In one patient there was a pulmonary recurrence, successfully treated with cisplatin-based salvage chemotherapy. One patient died from an accident but with no evidence of tumour, and 56 patients remained free of disease at a mean follow-up of 98.6 months. No patient died from disease. All patients had antegrade ejaculation after laparoscopic RPLND, as did 89% after open RPLND. CONCLUSION In this pilot study, the oncological efficacy of two cycles of cisplatin-based chemotherapy was favourable, but this approach still cannot be recommended as a standard treatment for patients with low-volume retroperitoneal stage II disease. RPLND after chemotherapy has diagnostic (detecting active tumour) and therapeutic (removing mature teratoma) value and can be done laparoscopically. Based on the present results a prospective randomized trial seems reasonable.
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Affiliation(s)
- Hannes Steiner
- Department of Urology, University of Innsbruck, Austria.
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28
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Yoon GH, Stein JP, Skinner DG. Retroperitoneal lymph node dissection in the treatment of low-stage nonseminomatous germ cell tumors of the testicle: An update. Urol Oncol 2005; 23:168-77. [PMID: 15907716 DOI: 10.1016/j.urolonc.2005.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2004] [Revised: 11/23/2004] [Accepted: 12/02/2004] [Indexed: 11/29/2022]
Abstract
Nonseminomatous germ cell tumors (NSGCT) of the testicle are highly treatable and curable. The evolution of cancer control for this disease has shown an effective integration of medical and surgical approaches over the last 3 decades. Current emphasis in the therapy of NSGCT focuses on minimizing treatment-related morbidity while maintaining consistently high cure rates as previously seen. Retroperitoneal lymph node dissection (RPLND) in experienced hands is a critical component of the treatment armamentarium in this disease. RPLND is an accurate staging tool providing important information to determine the need for chemotherapy. When performed properly, RPLND eliminates the retroperitoneum as a site for relapse, which in turn provides emotional and psychological relief to the patient, and simplifies the follow-up protocol. RPLND alone can also provide high cure rates in patients with low clinical stage disease and high risk factors, such as lymphovascular invasion or predominance of embryonal histology in the primary tumor. Teratoma is chemoresistant and, when present in the primary tumor of patients with low stage, may be best treated with primary RPLND. Primary chemotherapy in the treatment of low stage NSGCT deserves continual investigation as long-term toxicities become more apparent. Observation is an option for the highly motivated patient but requires a rigorous follow-up schedule to avoid relapse. Laparoscopic RPLND is a viable staging tool; however, oncologic control of the retroperitoneum has not been reliably determined.
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Affiliation(s)
- Gerald H Yoon
- USC/Norris Comprehensive Cancer Center, Los Angeles, CA 90089-9178, USA.
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29
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Abstract
Tissue-specific stem cells play a key role in organ homoeostasis. They are relatively well characterized in systems which undergo constant proliferation and production of differentiated cells, including the haemopoietic system, skin and intestine. However, little is known about the role and regulation of stem cells in the mammary gland. This review briefly summarizes the current understanding of the role of breast-specific stem cells in normal and cancerous tissues, and how this may identify new targets for breast cancer prevention and therapy.
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30
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Yoon GH, Stein JP, Skinner DG. Retroperitoneal lymph node dissection in the treatment of low-stage nonseminomatous germ cell tumors of the testicle. Expert Rev Anticancer Ther 2005; 5:75-85. [PMID: 15757440 DOI: 10.1586/14737140.5.1.75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Nonseminomatous germ cell tumors of the testicle are highly treatable and curable. The evolution of cancer control for this disease has demonstrated an effective integration of medical and surgical approaches over the last 30 years. Current emphasis in the therapy of nonseminomatous germ cell tumors focuses on minimizing treatment-related morbidity while maintaining consistently high cure rates. Retroperitoneal lymph node dissection in experienced hands is a critical component of the treatment armamentarium in this disease. Retroperitoneal lymph node dissection is an accurate staging tool that provides important information in determining the need for chemotherapy. When performed properly, retroperitoneal lymph node dissection eliminates the retroperitoneum as a site for relapse, which in turn provides emotional and psychological relief to the patient and simplifies the follow-up protocol. Retroperitoneal lymph node dissection alone can also provide high cure rates in patients with clinical low-stage disease and high-risk factors such as lymphovascular invasion or predominance of embryonal histology in the primary tumor. Teratoma is known to be chemoresistant and, when present in the primary tumor of low-stage patients, may be best treated with primary retroperitoneal lymph node dissection. Primary chemotherapy in the treatment of low-stage nonseminomatous germ cell tumors deserves continual investigation as long-term toxicities become more apparent. Observation is an option for the highly motivated patient, but requires a rigorous follow-up schedule to avoid relapse. Laparoscopic retroperitoneal lymph node dissection is a viable staging tool, however, oncologic control of the retroperitoneum has not been reliably determined.
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Affiliation(s)
- Gerald H Yoon
- USC/Norris Comprehensive Cancer Center, 1441 Eastlake Avenue, Suite 7416, Mail Stop74, Los Angeles, CA 90089-9178, USA.
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31
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Fosså SD, Magelssen H. Fertility and reproduction after chemotherapy of adult cancer patients: malignant lymphoma and testicular cancer. Ann Oncol 2004; 15 Suppl 4:iv259-65. [PMID: 15477318 DOI: 10.1093/annonc/mdh936] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S D Fosså
- Department of Clinical Cancer Research, Unit for Long-term Outcome, Norwegian Radium Hospital, Oslo
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32
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Pectasides D, Pectasides M, Farmakis D, Nikolaou M, Koumpou M, Kostopoulou V, Mylonakis N. Testicular Function in Patients with Testicular Cancer Treated with Bleomycin-Etoposide-Carboplatin (BEC90) Combination Chemotherapy. Eur Urol 2004; 45:187-93. [PMID: 14734005 DOI: 10.1016/j.eururo.2003.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate the impact of bleomycin-etoposide-carboplatin combination chemotherapy on long-term fertility in patients with testicular germ cell tumors. METHODS Twenty-five patients with high risk stage I and IM non-seminomatous germ cell tumors (NSGCT, Group A) and 44 with advanced seminoma or NSGCT (Group B) were treated with bleomycin 30 mg (days 2, 9, 16), etoposide 165 mg/m(2) (days 1-3) and carboplatin 400mg/m(2) or AUC 5 (day 1) (BEC(90)). Treatment was repeated every 3 weeks. Group A patients received 2 cycles of BEC(90), while Group B ones received 4 to 5 cycles of BEC(90). Sperm count and hormonal analyses were examined pre- and post-chemotherapy. Counts were classified as normospermia (NS) if >20 x 10(6)ml(-1), oligospermia (OS) if 1-20 x 10(6)ml(-1) and azoospermia (AS) if <1 x 10(6)ml(-1). RESULTS Patients were followed for a median of 2.9 years post-chemotherapy. The post-orchidectomy median luteinizing hormone (LH) serum levels were slightly above the upper normal limit while the serum levels of follicle stimulating hormone (FSH) and testosterone (T) were within the reference interval. Thirty-eight (55%) patients had NS pre-chemotherapy. None of the 14 NS patients who received 2 cycles of BEC(90) had AS post-chemotherapy, while only 1 of the 24 NS patients who were treated with > or =4 cycles of BEC(90) had AS post-treatment. Among the NS patients, 93% and 83%, respectively, remained NS following chemotherapy. Overall, 90% of patients had recovery (61% NS, 29% OS) of spermatogenesis after treatment. The median FSH serum values were significantly elevated at least 1-year post-chemotherapy when compared with the pre-treatment levels. Eighteen months post-chemotherapy the median FSH values had returned to the reference limits. Serum LH and T levels were unaffected by treatment. The pre-treatment sperm count and the bulk of disease were significantly associated with recovery of spermatogenesis. No association was found between recovery of spermatogenesis and 2 or > or =4 cycles of chemotherapy, age > or =30 years and post-chemotherapy lymph node dissection. Thirteen patients (4 with OS) fathered 16 children. No congenital abnormalities occurred in any of these children. CONCLUSION The BEC(90) regimen has no major effect on fertility and Leydig cell function. However, carboplatin-based chemotherapy has been proved less effective than cisplatin-based chemotherapy and is not currently used in the treatment of testicular cancer.
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Affiliation(s)
- Dimitrios Pectasides
- 2nd Department of Medical Oncology, Metaxas Memorial Cancer Hospital, 51 Botassi St, 18537 Piraeus, Greece.
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Gaffan J, Holden L, Newlands ES, Short D, Fuller S, Begent RHJ, Rustin GJS, Seckl MJ. Infertility rates following POMB/ACE chemotherapy for male and female germ cell tumours - a retrospective long-term follow-up study. Br J Cancer 2004; 89:1849-54. [PMID: 14612891 PMCID: PMC2394462 DOI: 10.1038/sj.bjc.6601383] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The risk of chemotherapy-induced infertility in male and female germ cell tumour (GCT) survivors is unclear, but may correlate with cisplatin dose. Here, we examine a large series of GCT patients for the effect of chemotherapy on those attempting to have children. Our GCT database was screened for nonseminomatous GCT patients who had (1) received POMB/ACE chemotherapy (cisplatin, vincristine, methotrexate, bleomycin alternating with actinomycin D, cyclophosphamide and etoposide) and (2) stage I male GCT patients who were untreated between 1977 and 1996. Fertility was assessed by questionnaire and medical records. A total of 64 of 153 treated and 35 of 115 untreated men attempted to have children. In all, 28% (18 out of 64) receiving POMB/ACE were unsuccessful. Radiotherapy (six), atrophic remaining testis (one) or prior infertility (three) were implicated in 10 cases, so chemotherapy-induced infertility may have occurred in only 11% (eight out of 64). Strikingly, 26% (nine out of 35) of untreated stage I patients also failed to have children (three had radiotherapy, three prior infertility). Moreover, in treated men, no association was seen between cisplatin dose and infertility. In contrast, radiotherapy significantly increased male infertility (P=0.001). Of 28 treated women who attempted to have children, 25% (seven out of 28) were unsuccessful. One previously had infertility and one subsequently had successful IVF so chemotherapy-induced infertility potentially occurred in only 18% (five out of 28) and was not related to cisplatin dose. In conclusion, the risk of chemotherapy-induced infertility is low in both male and female GCT patients and does not clearly correlate with the cumulative cisplatin dose.
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Affiliation(s)
- J Gaffan
- Department of Medical Oncology, Charing Cross Campus of Imperial College London, Fulham Palace Rd, London W6 8RF, UK
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Affiliation(s)
- Ricardo Pardal
- Howard Hughes Medical Institute, and Departments of Internal Medicine and Cell and Developmental Biology, University of Michigan, 3215 CCGC, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0934, USA
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35
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Roark KM, Waddell JA, Solimando DA. Bleomycin, Etoposide, and Cisplatin (BEP) Regimen for Testicular Cancer. Hosp Pharm 2003. [DOI: 10.1177/001857870303800702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column focuses on the commercially available and investigational agents used to treat malignant diseases and reviews issues related to the preparation, dispensing, and administration of cancer chemotherapy.
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Affiliation(s)
| | - J. Aubrey Waddell
- Oncology Pharmacy Residency Program, Department of Pharmacy, Walter Reed Army Medical Center, 6900 Georgia Avenue, NW, Room 2P02, Washington, DC 20307–5001
| | - Dominic A. Solimando
- Oncology Pharmacy Services, Inc., 4201 Wilson Boulevard #110–545, Arlington, VA 22203
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Ozawa N, Goda N, Makino N, Yamaguchi T, Yoshimura Y, Suematsu M. Leydig cell-derived heme oxygenase-1 regulates apoptosis of premeiotic germ cells in response to stress. J Clin Invest 2002. [PMID: 11854317 DOI: 10.1172/jci0213190] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Stress-induced downregulation of spermatogenesis remains poorly understood. This study examined the induction of heme oxygenase-1 (HO-1), a carbon monoxide-generating inducible enzyme, in modulation of spermatogenesis. Rats were exposed to cadmium chloride (CdCl(2)), a stressor causing oligozoospermia, and HO-1-induction was monitored by following HO isozyme expression. CdCl(2)-treated testes increased HO-1 activity and suppressed microsomal cytochromes P450, which are required for steroidogenesis. CdCl(2)-elicited HO-1 occurred mostly in Leydig cells and coincided with CO generation, as judged by bilirubin-IXalpha immunoreactivity. Under these circumstances, germ cells in peripheral regions of seminiferous tubules exhibited apoptosis; laser flow cytometry revealed that these apoptotic cells involve diploid and tetraploid germ cells, suggesting involvement of spermatogonia and primary spermatocytes in CdCl(2)-elicited apoptosis. Pretreatment with zinc protoporphyrin-IX, an HO inhibitor, but not copper protoporphyrin-IX, which does not block the enzyme, attenuated the CdCl(2)-induced apoptosis. Such antiapoptotic effects of zinc protoporphyrin-IX were repressed by supplementation of dichloromethane, a CO donor. Upon CdCl(2)-treatment, both Sertoli cells and the germ cells upregulated Fas ligand; this event was also suppressed by zinc protoporphyrin-IX and restored by dichloromethane. Thus, Leydig cells appear to use HO-1-derived CO to trigger apoptosis of premeiotic germ cells and thereby modulate spermatogenesis under conditions of stress.
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Affiliation(s)
- Nobuaki Ozawa
- Department of Obstetrics and Gynecology, School of Medicine, Keio University, Tokyo, Japan
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Ozawa N, Goda N, Makino N, Yamaguchi T, Yoshimura Y, Suematsu M. Leydig cell-derived heme oxygenase-1 regulates apoptosis of premeiotic germ cells in response to stress. J Clin Invest 2002; 109:457-67. [PMID: 11854317 PMCID: PMC150871 DOI: 10.1172/jci13190] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Stress-induced downregulation of spermatogenesis remains poorly understood. This study examined the induction of heme oxygenase-1 (HO-1), a carbon monoxide-generating inducible enzyme, in modulation of spermatogenesis. Rats were exposed to cadmium chloride (CdCl(2)), a stressor causing oligozoospermia, and HO-1-induction was monitored by following HO isozyme expression. CdCl(2)-treated testes increased HO-1 activity and suppressed microsomal cytochromes P450, which are required for steroidogenesis. CdCl(2)-elicited HO-1 occurred mostly in Leydig cells and coincided with CO generation, as judged by bilirubin-IXalpha immunoreactivity. Under these circumstances, germ cells in peripheral regions of seminiferous tubules exhibited apoptosis; laser flow cytometry revealed that these apoptotic cells involve diploid and tetraploid germ cells, suggesting involvement of spermatogonia and primary spermatocytes in CdCl(2)-elicited apoptosis. Pretreatment with zinc protoporphyrin-IX, an HO inhibitor, but not copper protoporphyrin-IX, which does not block the enzyme, attenuated the CdCl(2)-induced apoptosis. Such antiapoptotic effects of zinc protoporphyrin-IX were repressed by supplementation of dichloromethane, a CO donor. Upon CdCl(2)-treatment, both Sertoli cells and the germ cells upregulated Fas ligand; this event was also suppressed by zinc protoporphyrin-IX and restored by dichloromethane. Thus, Leydig cells appear to use HO-1-derived CO to trigger apoptosis of premeiotic germ cells and thereby modulate spermatogenesis under conditions of stress.
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Affiliation(s)
- Nobuaki Ozawa
- Department of Obstetrics and Gynecology, School of Medicine, Keio University, Tokyo, Japan
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Damani MN, Master V, Meng MV, Burgess C, Turek P, Oates RD, Masters V. Postchemotherapy ejaculatory azoospermia: fatherhood with sperm from testis tissue with intracytoplasmic sperm injection. J Clin Oncol 2002; 20:930-6. [PMID: 11844813 DOI: 10.1200/jco.2002.20.4.930] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To define the success of testis sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI) in azoospermic men with a history of chemotherapy. PATIENTS AND METHODS In a retrospective study, 23 men with ejaculatory azoospermia and a history of chemotherapy underwent TESE in a search for usable spermatozoa. In six patients cryopreserved tissue and in nine patients fresh tissue provided sperm for an ICSI cycle. Histologic analysis of the testis was performed in all patients. The presence or absence of sperm, fertilization rates with ICSI, and final outcomes of pregnancy were recorded. RESULTS Spermatozoa were found on TESE in 15 (65.2%) of 23 men. On histopathology, the predominant pattern observed was Sertoli cell only (47.8%), followed by hypospermatogenesis (30.4%), mixed (17.4%), and late maturation arrest (4.3%). The fertilization rate was 65.2%, and ongoing/delivered pregnancies occurred in 30.8% of cycles. Six healthy boys and four healthy girls have been born to date. CONCLUSION Men who are azoospermic and have had prior cytotoxic therapy make up a small subgroup of males with nonobstructive azoospermia. It is important to define and characterize this subgroup and better define their true fertility potential. Approximately two thirds of these men have retrievable testis sperm, which may be used with ICSI to have healthy offspring. This exciting avenue for paternity has heretofore not been available to such patients.
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Affiliation(s)
- M N Damani
- Department of Urology, Boston University School of Medicine, Boston, MA, USA
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Schrader M, Müller M, Straub B, Miller K. The impact of chemotherapy on male fertility: a survey of the biologic basis and clinical aspects. Reprod Toxicol 2001; 15:611-7. [PMID: 11738514 DOI: 10.1016/s0890-6238(01)00182-4] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The introduction of cisplatin-based polychemotherapy has led to cure rates of up to 90% for the most frequent malignant diseases seen in young men. In view of these high cure rates, increasing clinical importance is now being attached to chemotherapy-induced fertility disorders. Comparative studies examining the impact of cytotoxic chemotherapy on gametogenesis demonstrate significant cytostatic- and dose-specific differences. The extensive literature on possible teratogenic effects of chemotherapy provides no evidence suggesting that offspring of patients with a history of chemotherapy have an increased risk of malformations. However, these studies, the scope and follow-up of which may still be inadequate, have failed to eliminate the fear of such risk. Hormonal protection from chemotherapy-induced testicular damage has thus far succeeded only in animal models pretreated by application of gonadotropin-releasing hormone agonists combined with nonsteroidal antiandrogens or testosterone plus 17 beta-estradiol. The same holds true for hormone therapy aimed at stimulating the recovery of spermatogenesis after chemotherapy-induced testicular damage. Cryopreservation of germ cells can be suggested to patients undergoing cytostatic therapy. In some cases, testicular extraction of spermatozoa can also be offered as a novel approach.
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Affiliation(s)
- M Schrader
- Department of Urology, University Hospital Benjamin Franklin, Free University of Berlin, Hindenburgdamm 30, 12200 Berlin, Germany.
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Terenziani M, Massimino M, Casanova M, Cefalo G, Ferrari A, Luksch R, Spreafico F, Polastri D, Fontanelli R, Piva L, Fossati-Bellani F. Childhood malignant ovarian germ cell tumors: a monoinstitutional experience. Gynecol Oncol 2001; 81:436-40. [PMID: 11371135 DOI: 10.1006/gyno.2001.6177] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We reviewed our 23-year monoinstitutional exprience with childhood malignant ovarian germ cell tumors (MOGCT), with respect to survival and iatrogenic sequelae. METHODS Twenty-nine patients (median age 12 years) with newly diagnosed MOGCT were treated: all girls but 2 underwent surgery as initial treatment. There were 9 pure dysgerminomas and 20 nondysgerminoma tumors (5 immature teratomas, 4 yolk sac tumors, and 11 mixed histology tumors). According to the FIGO classification, 9 girls were classified as stage I, 4 as II, 11 as III, and 3 as IV, and 2 were not evaluable because they were submitted to primary chemotherapy. Twenty-four received chemotherapy with VAC, PVB, or PEB regimens, according to the ongoing protocols through the years. Three stage I girls did not receive adjuvant chemotherapy because of their histology (2 dysgerminomas, 1 immature teratoma) and stage. In the early years, postoperative radiotherapy was given alone in advanced dysgerminoma stages. RESULTS Five patients died of their disease: 2 dysgerminomas (stage IIIc and IV) and 3 nondysgerminomas (2 stage II and 1 stage IIIc). OS and EFS rates at a median of 112 months were 81.8%. Among 24 survivors, 4 experienced iatrogenic amenorrhea because of radiotherapy and/or bilateral oophorectomy. CONCLUSIONS MOGCT are highly chemosensitive and curable, with preservation of reproductive function. The management of recurrent disease remains an open issue.
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Affiliation(s)
- M Terenziani
- Pediatric Oncology Unit, Istituto Nazionale Tumori, Milan, 20133, Italy
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Gerl A, Mühlbayer D, Hansmann G, Mraz W, Hiddemann W. The impact of chemotherapy on Leydig cell function in long term survivors of germ cell tumors. Cancer 2001; 91:1297-303. [PMID: 11283930 DOI: 10.1002/1097-0142(20010401)91:7<1297::aid-cncr1132>3.0.co;2-z] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Because patients with germ cell tumors expect an additional life span of around 50 years after successful treatment, attention is now focused on potential long term toxicity. Limited data are available on Leydig cell function in long term survivors. METHODS The authors measured testosterone, sex hormone binding-globulin (SHBG), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) levels in 244 patients with germ cell tumors. Patients were divided into three groups: Group 1 had received no chemotherapy (n = 58 patients), Group 2 had received cumulative doses of cisplatin < or = 400 mg/m(2) (n = 117 patients), and Group 3 had received cumulative doses of cisplatin > 400 mg/m(2) (n = 69 patients). The median times from chemotherapy were 74 months and 75 months in Groups 2 and 3, respectively. RESULTS Subnormal testosterone levels (< 10 nmol/L) were found in 5%, 11%, and 20% in Groups 1, 2, and 3, respectively (Group 1 vs. Group 3; P = 0.02). The mean testosterone level and the testosterone/SHBG ratio did not differ significantly between Groups 1 and 2; however, they did differ between Groups 1 and 3 (testosterone: 17.0 nmol/L vs. 14.9 nmol/L, respectively; P = 0.02; testosterone/SHBG ratio: 0.70 vs. 0.59; P < 0.05). There was a significant inverse correlation between the testosterone/SHBG ratio and LH (correlation coefficient [r] = -0.25; P = 0.0002). A significant positive correlation was found for LH and FSH (r = 0.78; P < 0.0001), indicating a strong association between Leydig cell dysfunction and germinal epithelial damage. CONCLUSIONS Standard doses of cisplatin-based chemotherapy do not lead to a significant deterioration of Leydig cell function in long term survivors of germ cell tumors. In contrast, high cumulative doses of chemotherapy cause a significant and persistent impairment of Leydig cell function. More data are needed regarding the clinical relevance of moderate testosterone deficiency. Further research is necessary to determine whether some patients may benefit from testosterone replacement.
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Affiliation(s)
- A Gerl
- Department of Internal Medicine III (Hematology/Medical Oncology), Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
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Bokemeyer C, Kollmannsberger C, Hartmann JT, Kanz L. Follow up after primary treatment: curable diseases treated non-surgically. Ann Oncol 2001; 11 Suppl 3:73-8. [PMID: 11079122 DOI: 10.1093/annonc/11.suppl_3.73] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Bokemeyer
- Department of Hematology and Oncology, University of Tuebingen, Germany
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De Palma A, Vicari E, Palermo I, D'Agata R, Calogero AE. Effects of cancer and anti-neoplastic treatment on the human testicular function. J Endocrinol Invest 2000; 23:690-6. [PMID: 11097435 DOI: 10.1007/bf03343795] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Men with testicular neoplasia (TN) and Hodgkin's disease (HD) are those who more frequently require treatment for fertility because these malignancies affect patients during the reproductive age and because the early diagnosis and the improved anti-neoplastic treatments cure most of these patients. Although some of them can father a child spontaneously, assisted reproductive techniques allow fatherhood to patients with severe spermatogenesis impairment and this possibility has raised concern about the long-term consequence of the testicular damage induced by chemo- and/or radiotherapy. This paper reviews the effects of cancer per se and of anti-neoplastic treatments on gonadal function, sperm aneuploidy rate and sperm DNA integrity. A debate is still open as to whether TN or HD per se may impair spermatogenesis. Many studies have shown that this is the case, albeit others have challenged this view. Chemo- and/or radiotherapy affects negatively gonadal function, rendering almost all patients azoospermics. However, spontaneous pregnancies and a high degree of spermatogenesis recovery occur with time. A large body of literature on sperm chromosome complement suggests an increased rate of structural and numerical chromosome abnormalities in patients with cancer during anti-neoplastic treatment. A minority of them has, however, shown that this effect disappears with time. An interesting and relatively new aspect is the study of sperm DNA integrity in patients with TN and HD particularly following chemo- and/or radiotherapy. The scanty information available seems to suggest that these patients have a permanent or at least a long-lasting DNA fragmentation in their spermatozoa.
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Affiliation(s)
- A De Palma
- Department of Internal Medicine, University of Catania Medical School, Italy
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Auger J, Kuntsmann JM, Czyglik F, Jouannet P. Prévention des risques d’infertilité liés aux traitements antitumoraux dans le cancer du testicule. ACTA ACUST UNITED AC 2000. [DOI: 10.1007/bf03034371] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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RETROPERITONEAL LYMPH NODE DISSECTION FOR THE MANAGEMENT OF CLINICAL STAGE I NONSEMINOMA. J Urol 2000. [DOI: 10.1097/00005392-200006000-00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kollmannsberger C, Kuzcyk M, Mayer F, Hartmann JT, Kanz L, Bokemeyer C. Late toxicity following curative treatment of testicular cancer. SEMINARS IN SURGICAL ONCOLOGY 1999; 17:275-81. [PMID: 10588857 DOI: 10.1002/(sici)1098-2388(199912)17:4<275::aid-ssu9>3.0.co;2-u] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cisplatin appears to be the major cause for long-term toxicity in patients treated for testicular cancer. Long-term side effects consist mainly of nephrotoxicity, ototoxicity, and neurotoxicity as well as gonadal damage. Following standard-dose chemotherapy approximately 20% to 30% of patients will be affected by long-term side effects, although not all these side effects will cause an impaired quality of life. Several strategies have been or currently are being evaluated to reduce acute and long-term complications including the introduction of equally effective, but less toxic regimens, or the use of cytoprotective agents such as amifostine. Secondary acute myeloid leukemia and secondary myelodysplastic syndrome probably represent the worst possible long-term complications of cancer therapy in those patients who originally were cured of their primary testicular cancer. Therapy-related solid tumors are mainly associated with the use of radiation therapy and the risk for developing a therapy-related solid tumor is increased approximately two to three times compared to the general population. In contrast, therapy-related leukemias are predominantly associated with chemotherapy, particularly with the use of topoisomerase-II inhibitors and alkylating agents. In general, the cumulative incidence of therapy-related leukemia following treatment of germ cell cancer is low. It is approximately 0.5% and 2% at 5 years of median follow-up for patients receiving etoposide at cumulative doses< or = 2 g/m(2) and >2 g/m(2), respectively. The risk-benefit analysis in patients with testicular cancer clearly favors the use of current treatment regimens including high-dose chemotherapy. However, even the acceptably low number of therapy-related long-term complications should encourage the search for equally effective but less toxic therapies. This review will highlight important available data about therapy-related toxicity and particularly, therapy-related malignancies following cisplatin-etoposide-based chemotherapy.
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Affiliation(s)
- C Kollmannsberger
- Department of Medicine, Division of Hematology/Oncology/Immunology/Rheumatology, University of Tübingen, Tübingen, Germany
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Mitchell PL, Al-Nasiri N, A'Hern R, Fisher C, Horwich A, Pinkerton CR, Shepherd JH, Gallagher C, Slevin M, Harper P, Osborne R, Mansi J, Oliver T, Gore ME. Treatment of nondysgerminomatous ovarian germ cell tumors: an analysis of 69 cases. Cancer 1999; 85:2232-44. [PMID: 10326703 DOI: 10.1002/(sici)1097-0142(19990515)85:10<2232::aid-cncr19>3.0.co;2-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Combination chemotherapy has dramatically improved the prognosis of patients with nondysgerminomatous ovarian germ cell tumors (NDOGCT). However, guidelines are needed for the identification of patients at risk of relapse. METHODS The authors performed a retrospective analysis of women with NDOGCT managed during the period 1970-1994 at the Royal Marsden Hospital and other hospitals of the London Gynaecological Oncology Group. RESULTS Sixty-nine women were included; their median follow-up was 5.7 years (minimum, 12 months). The median age was 21 years (range, 4-44 years), with a histology of immature teratoma (IT) for 17 patients, endodermal sinus tumor (EST) for 20 patients, and mixed tumors for 32 patients. Thirty-five patients (51%) had Stage I disease. Nine patients with Stage I tumors were observed without further therapy (six with IT and three with mixed tumors), and one relapsed. Seven patients received non-platinum-based chemotherapy, and four relapsed. A total of 52 patients were treated with platinum-based chemotherapy, with relapse free and overall survival rates of 87% (95% confidence interval [CI], 73-93%) and 84% (95% CI, 70-91%), respectively. Of these patients, relapse was seen in 0 of 9 IT patients, 1 of 25 patients with mixed tumors, and 6 of 18 EST patients. With alpha-fetoprotein (AFP) > 1000 kU/L, relapse was seen in 6 of 18 patients compared with 1 of 33 relapses with lower AFP levels. In multivariate analysis, including all patients who received chemotherapy, AFP >1000 kU/L (P = 0.001) and non-platinum-based chemotherapy (P = 0.005) were associated with relapse. When only patients given platinum-based treatment were considered, EST histology (P = 0.003) and AFP >1000 kU/L (P = 0.003) were associated with relapse in univariate analysis; however, these factors were linked. No malignant tumor was found at second-look surgery performed on 24 patients. Of 26 women assessable for fertility, 24 subsequently recommenced regular menstrual function, and 11 patients had pregnancies. CONCLUSIONS Platinum-based chemotherapy has been confirmed to be effective in the management of patients with NDOGCT. Relapses were principally seen among patients with AFP >1000 kU/L or pure EST histology. Efforts to improve outcome need to focus on patients with EST, whereas less intensive management strategies may be appropriate for some patients with IT.
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Mathé G. Iatrogen male infertility. Biomed Pharmacother 1998; 52:193-6. [PMID: 9755814 DOI: 10.1016/s0753-3322(98)80015-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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