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McHugh DJ, Gleeson JP, Feldman DR. Testicular cancer in 2023: Current status and recent progress. CA Cancer J Clin 2024; 74:167-186. [PMID: 37947355 DOI: 10.3322/caac.21819] [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: 07/20/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 11/12/2023] Open
Abstract
Testicular germ cell tumor (GCT) is the most common solid tumor in adolescent and young adult men. Progress in the management of GCT has been made in the last 50 years, with a substantial improvement in cure rates for advanced disease, from 25% in the 1970s to nearly 80%. However, relapsed or platinum-refractory disease occurs in a proportion, 20% of whom will die from disease progression. This article reviews the current evidence-based treatments for extracranial GCT, the acute and chronic toxic effects that may result, and highlights contemporary advances and progress in the field.
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Affiliation(s)
- Deaglan J McHugh
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medicine, New York, New York, USA
| | - Jack P Gleeson
- Cancer Research, College of Medicine and Health, University College Cork, Cork, Ireland
- Medical Oncology Department, Cork University Hospital, Cork, Ireland
| | - Darren R Feldman
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medicine, New York, New York, USA
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2
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Shamash J, Ng K. Balancing efficacy with long-term side-effects: can we safely de-escalate therapy for germ cell tumors? Expert Rev Anticancer Ther 2023; 23:127-134. [PMID: 36648077 DOI: 10.1080/14737140.2023.2162042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The success in the management of germ cell tumors has encouraged researchers to pay more attention on long-term side effects and other survivorship issues. The de-escalation of treatment is intended to reduce side effects but must be balanced against any compromise of efficacy. Cisplatin-based therapy is the cornerstone of treatment for germ cell tumors. However, they can result in acute and long-term side effects, including ototoxicity, neurotoxicity, nephrotoxicity, and increased risk of second malignancies. AREAS COVERED This review discusses approaches of de-escalation including biomarker-directed treatment using microRNAs, surveillance for immature teratoma, the use of carboplatin monotherapy for seminoma, and the option of non-cisplatin-based approaches in relapsed germ cell tumors. EXPERT OPINION While the results with the current standard options in terms of cancer control are very good, the price being paid in terms of long-term side effects is considerable.
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Affiliation(s)
| | - Kenrick Ng
- Medical Oncology, Barts Health NHS Trust, London, UK
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3
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TONYALI Ş. Testis Kanseri Tedavisinde Güncel Yaklaşım. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.30934/kusbed.960776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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4
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Kubeček O, Paterová P, Novosadová M. Risk Factors for Infections, Antibiotic Therapy, and Its Impact on Cancer Therapy Outcomes for Patients with Solid Tumors. Life (Basel) 2021; 11:1387. [PMID: 34947918 PMCID: PMC8705721 DOI: 10.3390/life11121387] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 12/12/2022] Open
Abstract
Infections represent a significant cause of morbidity and mortality in cancer patients. Multiple factors related to the patient, tumor, and cancer therapy can affect the risk of infection in patients with solid tumors. A thorough understanding of such factors can aid in the identification of patients with substantial risk of infection, allowing medical practitioners to tailor therapy and apply prophylactic measures to avoid serious complications. The use of novel treatment modalities, including targeted therapy and immunotherapy, brings diagnostic and therapeutic challenges into the management of infections in cancer patients. A growing body of evidence suggests that antibiotic therapy can modulate both toxicity and antitumor response induced by chemotherapy, radiotherapy, and especially immunotherapy. This article provides a comprehensive review of potential risk factors for infections and therapeutic approaches for the most prevalent infections in patients with solid tumors, and discusses the potential effect of antibiotic therapy on toxicity and efficacy of cancer therapy.
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Affiliation(s)
- Ondřej Kubeček
- Department of Oncology and Radiotherapy, Faculty of Medicine and University Hospital in Hradec Králové, Charles University, Sokolská 581, 50005 Hradec Králové, Czech Republic;
| | - Pavla Paterová
- Department of Clinical Microbiology, Faculty of Medicine and University Hospital in Hradec Králové, Charles University, Sokolská 581, 50005 Hradec Králové, Czech Republic
| | - Martina Novosadová
- Department of Clinical Pharmacy, Hospital Pharmacy, University Hospital in Hradec Králové, Sokolská 581, 50005 Hradec Králové, Czech Republic;
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Wang L, Zhao X, Fu J, Xu W, Yuan J. The Role of Tumour Metabolism in Cisplatin Resistance. Front Mol Biosci 2021; 8:691795. [PMID: 34250022 PMCID: PMC8261055 DOI: 10.3389/fmolb.2021.691795] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/10/2021] [Indexed: 12/18/2022] Open
Abstract
Cisplatin is a chemotherapy drug commonly used in cancer treatment. Tumour cells are more sensitive to cisplatin than normal cells. Cisplatin exerts an antitumour effect by interfering with DNA replication and transcription processes. However, the drug-resistance properties of tumour cells often cause loss of cisplatin efficacy and failure of chemotherapy, leading to tumour progression. Owing to the large amounts of energy and compounds required by tumour cells, metabolic reprogramming plays an important part in the occurrence and development of tumours. The interplay between DNA damage repair and metabolism also has an effect on cisplatin resistance; the molecular changes to glucose metabolism, amino acid metabolism, lipid metabolism, and other metabolic pathways affect the cisplatin resistance of tumour cells. Here, we review the mechanism of action of cisplatin, the mechanism of resistance to cisplatin, the role of metabolic remodelling in tumorigenesis and development, and the effects of common metabolic pathways on cisplatin resistance.
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Affiliation(s)
- Lude Wang
- Central Laboratory, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Xiaoya Zhao
- Central Laboratory, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Jianfei Fu
- Department of Medical Oncology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Wenxia Xu
- Central Laboratory, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Jianlie Yuan
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
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Merseburger AS, Geiges G, Klier J, Wiesholzer M, Pichler P. Pooled Analysis on the Effectiveness and Safety of Lipegfilgrastim in Patients With Urological Malignancies in the Real-World Setting. Front Oncol 2021; 11:655355. [PMID: 34123810 PMCID: PMC8195268 DOI: 10.3389/fonc.2021.655355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/21/2021] [Indexed: 01/13/2023] Open
Abstract
Lipegfilgrastim is a long-acting glycopegylated granulocyte-colony stimulating factor (G-CSF) approved for the management of chemotherapy-induced neutropenia. In general, there is little information on the use of any G-CSFs specifically in patients with urological malignancies receiving chemotherapy. This report combines information from two prospective non-interventional studies on the prophylactic use of lipegfilgrastim in urological cancer patients receiving chemotherapy in the real-world setting. Data were derived from two phase IV studies (NADIR and LEOS) with similar protocols conducted in nine European countries. Analysis included 228 patients (142 prostate, 50 testicular, 27 bladder, and 9 other urological cancers). Chemotherapy-induced febrile neutropenia risk was classified as high (43.0%), intermediate (49.1%), or low (7.5%). Lipegfilgrastim was administered as primary (n=180, 78.9%) or secondary (n=29, 12.7%) prophylaxis. The incidence of febrile neutropenia over all chemotherapy cycles (n=998) and first cycles (n=228) for which lipegfilgrastim was administered for prophylaxis was 2.6% and 1.3%, respectively. Corresponding results for Grade 3/4 neutropenia were 2.2% and 0.9%, respectively. Adverse drug reactions occurred in 24 patients (10.5%): those in more than one patient were bone pain (n=6, 2.6%) and pyrexia (n=3, 1.3%). The use of lipegfilgrastim for the prophylaxis of chemotherapy-induced neutropenia was effective and well tolerated in patients with urological malignancies in the real-world setting.
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Affiliation(s)
- Axel S Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | | | | | - Martin Wiesholzer
- Department of Internal Medicine I, University Hospital St. Poelten, Karl Landsteiner, University of Health Sciences, St. Poelten, Austria
| | - Petra Pichler
- Department of Internal Medicine I, University Hospital St. Poelten, Karl Landsteiner, University of Health Sciences, St. Poelten, Austria
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Abstract
PURPOSE OF REVIEW Although testicular cancer remains a highly curable malignancy, challenges and uncertainty still remain in certain aspects of management. Residual disease after chemotherapy in patients with germ cell tumors (GCT) remains one of these challenges. We aim to highlight the recent literature on the management of residual disease after chemotherapy in GCT and the emerging innovations that may provide further guidance into this area. RECENT FINDINGS A subset of patients with GCT will have residual disease after chemotherapy, and management of these patients involves highly skilled multidisciplinary experts including medical oncologists, surgeons, radiologists, and pathologists. Management options depend on histologic subtype, either seminoma or nonseminoma, and involve size criteria, possible further imaging modalities, and tumor markers. Even with these tools at highly specialized expert centers, uncertainty in management remains, and recent literature has explored the use of newer biomarkers to aid in these cases. SUMMARY Postchemotherapy residual masses in GCT can prove to be complicated cases to manage. Balancing survival with quality of life outcomes is important and requires a multidisciplinary team experienced in treating GCT.
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de Vries G, Rosas-Plaza X, van Vugt MATM, Gietema JA, de Jong S. Testicular cancer: Determinants of cisplatin sensitivity and novel therapeutic opportunities. Cancer Treat Rev 2020; 88:102054. [PMID: 32593915 DOI: 10.1016/j.ctrv.2020.102054] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 12/23/2022]
Abstract
Testicular cancer (TC) is the most common solid tumor among men aged between 15 and 40 years. TCs are highly aneuploid and the 12p isochromosome is the most frequent chromosomal abnormality. The mutation rate is of TC is low, with recurrent mutations in KIT and KRAS observed only at low frequency in seminomas. Overall cure rates are high, even in a metastatic setting, resulting from excellent cisplatin sensitivity of TCs. Factors contributing to the observed cisplatin sensitivity include defective DNA damage repair and a hypersensitive apoptotic response to DNA damage. Nonetheless, around 10-20% of TC patients with metastatic disease cannot be cured by cisplatin-based chemotherapy. Resistance mechanisms include downregulation of OCT4 and failure to induce PUMA and NOXA, elevated levels of MDM2, and hyperactivity of the PI3K/AKT/mTOR pathway. Several pre-clinical approaches have proven successful in overcoming cisplatin resistance, including specific targeting of PARP, MDM2 or AKT/mTOR combined with cisplatin. Finally, patient-derived xenograft models hold potential for mechanistic studies and pre-clinical validation of novel therapeutic strategies in TC. While clinical trials investigating targeted drugs have been disappointing, pre-clinical successes with chemotherapy and targeted drug combinations fuel the need for further investigation in clinical setting.
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Affiliation(s)
- Gerda de Vries
- Department of Medical Oncology, Cancer Research Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ximena Rosas-Plaza
- Department of Medical Oncology, Cancer Research Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marcel A T M van Vugt
- Department of Medical Oncology, Cancer Research Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jourik A Gietema
- Department of Medical Oncology, Cancer Research Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Steven de Jong
- Department of Medical Oncology, Cancer Research Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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10
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Abstract
There are several treatment approaches for stage II germ cell tumors (GCTs), and a thorough understanding of the staging classification and histologic differences in tumor biology and therapeutic responsiveness is critical to determine an effective, multimodal management strategy that involves urologists, medical oncologists, and radiation oncologists. This article discusses contemporary management strategies for stage II GCTs, including chemotherapy, radiotherapy, retroperitoneal lymph node dissection (RPLND), and surveillance. Patient selection, histology, and extent of lymphadenopathy drive management, and, as both treatment and detection strategies continue to emerge and be refined, the management of patients with stage II GCT continues to evolve.
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Affiliation(s)
- Rashed A Ghandour
- Department of Urology, University of Texas Southwestern Medical Center, 2001 Inwood Road, 4th Floor, Dallas, TX 75390-9110, USA
| | - Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center, 2001 Inwood Road, 4th Floor, Dallas, TX 75390-9110, USA
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern Medical Center, 2001 Inwood Road, 4th Floor, Dallas, TX 75390-9110, USA.
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Murthy V, Johnny C, Huddart R. Positron Emission Tomography-Positive Post-Chemotherapy Seminoma Masses: Time to Reevaluate the Role of Radiotherapy? J Clin Oncol 2019; 37:937-938. [PMID: 30811289 DOI: 10.1200/jco.18.01991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Vedang Murthy
- Vedang Murthy, MD, and Carlton Johnny, MBBS, Tata Memorial Centre, Mumbai, India; and Robert Huddart, PhD, Institute of Cancer Research and Royal Marsden Hospital NHS, London, United Kingdom
| | - Carlton Johnny
- Vedang Murthy, MD, and Carlton Johnny, MBBS, Tata Memorial Centre, Mumbai, India; and Robert Huddart, PhD, Institute of Cancer Research and Royal Marsden Hospital NHS, London, United Kingdom
| | - Robert Huddart
- Vedang Murthy, MD, and Carlton Johnny, MBBS, Tata Memorial Centre, Mumbai, India; and Robert Huddart, PhD, Institute of Cancer Research and Royal Marsden Hospital NHS, London, United Kingdom
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12
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Abstract
Testicular cancer is a rare urological malignancy with high cure rate. The development of highly effective systemic treatment regimens along with advances in surgical treatment of advanced disease has led to continued improvement in outcomes. Patients with testicular cancer who are treated following the treatment guideline mostly achieved high quality of life and long-term survival. However, patients who were identified as having non-guideline directed care were at significantly higher risk of relapse. In this book chapter, we introduce in depth the modern management of testicular cancer, including diagnosis, staging and risk stratification, treatment strategies of seminoma and non-seminoma germ cell tumors, follow-up protocols, and salvage treatment for disease relapse. We also review new studies and updates on medical and surgical management of advanced testicular cancer.
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Abstract
The introduction of cisplatin combination chemotherapy, 40 years ago, transformed metastatic testicular germ cell tumors from an almost uniformly fatal disease into a model for a curable neoplasm. Before the era of platinum combination chemotherapy, the 5-year survival rate among men with metastatic testicular germ cell tumors was 5% to 10%. Currently, the 5-year survival rate is 80% for patients with metastatic disease and 95% overall. Despite the substantial advances in the treatment of germ cell tumors, 20% to 30% of patients will relapse after first-line chemotherapy and will require additional salvage therapies. Standard-dose or high-dose chemotherapy can cure ≤ 50% of these patients. Relapses after high-dose chemotherapy generally carry a poor prognosis; however, cure is still possible in a small percentage of patients by using further salvage chemotherapy or salvage surgery.
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Abstract
PURPOSE OF REVIEW We review current management strategies for patients with relapsed and refractory germ cell tumors (GCTs), defined as relapsed or persistent disease following at least one line of cisplatin-based chemotherapy. Additionally, we discuss future directions in the management of these patients. RECENT FINDINGS Recent studies involving targeted therapies have been disappointing. Nevertheless, studies of the management of refractory germ cell cancer are ongoing, with a focus on optimal utilization of high-dose chemotherapy and autologous stem cell transplant, as well as the role of immune checkpoint inhibitors in refractory germ cell tumors. Studies aiming to identify those patients who may benefit from more intensive treatment up front to prevent the development of refractory disease are also in progress. Testicular germ cell tumors are among the most curable of all solid tumor malignancies, with cure being possible even in the refractory, metastatic setting. Treatment of refractory disease remains a challenging clinical scenario, but potentially practice changing studies are ongoing.
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Petrelli F, Coinu A, Rosti G, Pedrazzoli P, Barni S. Salvage treatment for testicular cancer with standard- or high-dose chemotherapy: a systematic review of 59 studies. Med Oncol 2017; 34:133. [DOI: 10.1007/s12032-017-0990-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 06/23/2017] [Indexed: 11/24/2022]
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Abstract
Testicular germ cell tumours (GCTs) are the most common malignancy occurring in young adult men and the incidence of these tumours is increasing. Current research priorities in this field include improving overall survival for patients classified as being 'poor-risk' and reducing late effects of treatment for patients classified as 'good-risk'. Testicular GCTs are broadly classified into seminomas and nonseminomatous GCTs (NSGCTs). The conventional serum protein tumour markers α-fetoprotein (AFP), human chorionic gonadotrophin (hCG) and lactate dehydrogenase (LDH) show some utility in the management of testicular malignant GCT. However, AFP and hCG display limited sensitivity and specificity, being indicative of yolk sac tumour (AFP) and choriocarcinoma or syncytiotrophoblast (hCG) subtypes. Furthermore, LDH is a very nonspecific biomarker. Consequently, seminomas and NSGCTs comprising a pure embryonal carcinoma subtype are generally negative for these conventional markers. As a result, novel universal biomarkers for testicular malignant GCTs are required. MicroRNAs are short, non-protein-coding RNAs that show much general promise as biomarkers. MicroRNAs from two 'clusters', miR-371-373 and miR-302-367, are overexpressed in all malignant GCTs, regardless of age (adult or paediatric), site (gonadal or extragonadal) and subtype (seminomas, yolk sac tumours or embryonal carcinomas). A panel of four circulating microRNAs from these two clusters (miR-371a-3p, miR-372-3p, miR-373-3p and miR-367-3p) is highly sensitive and specific for the diagnosis of malignant GCT, including seminoma and embryonal carcinoma. In the future, circulating microRNAs might be useful in diagnosis, disease monitoring and prognostication of malignant testicular GCTs, which might also reduce reliance on serial CT scanning. For translation into clinical practice, important practical considerations now need addressing.
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Salvage High-Dose Chemotherapy for Relapsed Pure Seminoma in the Last 10 Years: Results From the European Society for Blood and Marrow Transplantation Series 2002-2012. Clin Genitourin Cancer 2016; 15:163-167. [PMID: 27444987 DOI: 10.1016/j.clgc.2016.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 05/21/2016] [Accepted: 06/11/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND The optimal management of advanced seminoma that relapses after chemotherapy remains unknown. We retrospectively analyzed outcomes with the use of high-dose chemotherapy (HDCT). PATIENTS AND METHODS Eligibility included adult male patients with pure seminomatous histology and treatment with salvage HDCT. Data of patients who received HDCT from 13 European Society for Blood and Marrow Transplantation (EBMT) centers were used. Multivariable Cox analyses evaluated the association of prespecified factors (line of treatment, prior radiotherapy, and chemosensitivity according to standard definition), with progression-free (PFS) and overall survival (OS). The prognostic ability of the model was assessed through the concordance statistic. RESULTS From December 2002 to December 2012, 46 cases were identified. Median age was 38 years (interquartile range, 35-46 years). HDCT was provided as second-line therapy (n = 14, 30.4%) and in third-line or beyond third-line therapy (n = 20, 43.5%; 12 had missing information). Sixteen patients (34.8%) received paraortic and/or iliac radiotherapy, and 10 (21.7%) had disease that was cisplatin refractory or absolutely refractory. Median follow-up was 22 months (interquartile range, 8-56). On multivariable Cox analysis, refractory disease was a significantly negative prognostic factor for both PFS (hazard ratio, 6.04; 95% confidence interval, 1.86-19.64) and OS (hazard ratio, 3.93; 95% confidence interval, 1.07-14.45), while prior radiotherapy trended to significance for both. The c index was 0.74 and 0.66 for PFS and OS, respectively. The small numbers and the lack of any comparison with conventional-dose chemotherapy are major study limitations. CONCLUSION Despite our small sample size, this retrospective analysis suggested that HDCT may represent a valuable therapeutic option for patients with a pure seminoma after standard-dose chemotherapy failure. Our observation requires validation through a prospective study.
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Survival Analysis of Pure Seminoma at Post-Chemotherapy Retroperitoneal Lymph Node Dissection. J Urol 2014; 192:1397-402. [DOI: 10.1016/j.juro.2014.04.097] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2014] [Indexed: 11/21/2022]
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Stein ME, Drumea K, Charas T, Gershuny A, Ben-Yosef R. Platinum-based Chemotherapy in Primary Advanced Seminoma-a Retrospective Analysis: Treatment Results at the Northern Israel Oncology Center (1989-2010). Rambam Maimonides Med J 2014; 5:e0005. [PMID: 24498512 PMCID: PMC3904480 DOI: 10.5041/rmmj.10139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Over the past 30 years, great strides have been made in the treatment of disseminated testicular tumors. Despite the low number of patients and the rarity of studies concerning primary advanced seminoma, the efficacy of chemotherapy is clear, mainly 3-4-cisplatin-based chemotherapy. Aiming to contribute to the understanding and implementation of proper chemotherapeutic management in advanced seminoma patients, we retrospectively summarized our experience with 26 patients who were referred for platinum-based chemotherapy, post-orchiectomy to the Northern Israel Oncology Center between 1989 and 2010. Response rate, side effects, and long-term outcome were investigated. METHODS Before chemotherapy, meticulous staging was done, including tumor markers (B-human chorionic gonadotropin (B-HCG), alpha-fetoprotein (AFP), and lactic dehydrogenase (LDH)), and abdominal and pelvic computerized tomography (CT) scans were carried out. RESULTS All 26 treated patients achieved complete remission, clinically and symptomatically, with normalization of their CT scans. At a median follow-up of 120 months (range, 24-268 months) all patients are alive, without evidence of recurrent disease. One patient whose disease recurred twice achieved a third complete remission following salvage treatment with high-dose chemotherapy and autologous peripheral stem cell transplantation. Another patient, who preferred surveillance, relapsed abdominally after 9 months but achieved long-standing complete remission with cisplatin-based chemotherapy. Both these patients are alive with no evidence of disease. Three patients recovered uneventfully from bleomycin-induced pneumonitis. CONCLUSIONS Advanced seminoma is a highly curable disease using platinum-based chemotherapy. Our study confirms the efficacy and safety of cisplatin-based chemotherapy in the treatment of advanced seminoma.
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Affiliation(s)
- Moshe E. Stein
- Northern Israel Oncology Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel and
- To whom correspondence should be addressed. E-mail:
| | - Karen Drumea
- Northern Israel Oncology Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel and
| | - Tomer Charas
- Northern Israel Oncology Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel and
| | - Anthony Gershuny
- Department of Clinical Oncology & Radiation Therapy, Queen’s Hospital, Romford, Essex, UK
| | - Rahamim Ben-Yosef
- Northern Israel Oncology Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel and
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Deville JL, Flechon A, Bruyère F, Karsenty G, Guy L, Bastide C. [Chemotherapy in male external genital organs (testicular and penile cancer)]. Prog Urol 2013; 23:1265-70. [PMID: 24183085 DOI: 10.1016/j.purol.2013.08.321] [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: 08/27/2013] [Accepted: 08/28/2013] [Indexed: 10/26/2022]
Abstract
AIM To describe drugs used in the chemotherapy of testis and penis neoplasms. MATERIAL Bibliographical search was performed from the database Medline (National Library of Medicine, PubMed) and websites of the HAS and the ANSM. The search was focused on the characteristics, the mode of action, the efficiency and the side effects of the various drugs concerned. RESULTS Nowadays, the chemotherapy is perfectly codified in adjuvant treatment or in first-line treatment of metastatic testis cancer. A single dose of carboplatin for seminoma testicular (stage I) in adjuvant treatment situation is one of the latest advances. Concerning penis cancer, the optimal protocols validated by a high level of evidence are missing. CONCLUSION The chemotherapy in testis and penis neoplasms knew few advances in recent years. So, it is necessary to include patients in clinical research protocols.
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Affiliation(s)
- J-L Deville
- Service d'oncologie, hôpital de la Timone, Aix-Marseille université, AP-HM, 13385 Marseille cedex 5, France
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Durand X, Rigaud J, Avancès C, Camparo P, Fléchon A, Murez T, Sèbe P, Culine S, Iborra F, Mottet N, Coloby P, Soulié M. Recommandations en onco-urologie 2013 du CCAFU : Tumeurs germinales du testicule. Prog Urol 2013; 23 Suppl 2:S145-60. [DOI: 10.1016/s1166-7087(13)70052-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Fizazi K, Delva R, Caty A, Chevreau C, Kerbrat P, Rolland F, Priou F, Geoffrois L, Rixe O, Beuzeboc P, Malhaire JP, Culine S, Aubelle MS, Laplanche A. A risk-adapted study of cisplatin and etoposide, with or without ifosfamide, in patients with metastatic seminoma: results of the GETUG S99 multicenter prospective study. Eur Urol 2013; 65:381-6. [PMID: 24094847 DOI: 10.1016/j.eururo.2013.09.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 09/04/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Whether patients with good prognosis and intermediate/poor prognosis advanced seminoma should be treated differently has not been defined. OBJECTIVE To assess a risk-adapted chemotherapy regimen in patients with advanced seminoma. DESIGN, SETTING, AND PARTICIPANTS A total of 132 patients were included in this prospective study. Patients with a good prognosis according to the International Germ Cell Cancer Collaboration Group (IGGCCG) were treated with four cycles of cisplatin-etoposide (EP). Patients with an intermediate prognosis according to the IGCCCG (or a poor prognosis according to the Medical Research Council classification) were treated with four cycles of VIP (EP and ifosfamide) and granulocyte colony-stimulating factor (G-CSF). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Survival curves were estimated using the Kaplan-Meier method. RESULTS AND LIMITATIONS The median follow-up was 4.5 yr (range: 0.4-11.6 yr). Among 108 patients (82%) with a good prognosis who received EP, grade 3-4 toxicity included neutropenia (47%) and neutropenic fever (12%). Among the 24 patients (18%) with an intermediate/poor prognosis who received VIP plus G-CSF, toxicity included grade 3-4 neutropenia (36%), neutropenic fever (23%), thrombocytopenia (23%), anemia (23%), and a toxicity-related death (n=1; 4%). The 3-yr progression-free survival (PFS) rate was 93% (range: 85-97%) in the good prognosis group and 83% (range: 63-93%) in the intermediate/poor prognosis group (p=0.03 for PFS). The 3-yr overall survival (OS) rate was 99% (range: 92-100%) and 87% (range: 67-95%), respectively (p<0.005 for OS). Only four patients died of seminoma or its treatment. CONCLUSIONS A risk-adapted chemotherapy policy for advanced seminoma yielded an excellent outcome with a 3-yr OS rate of 96%.
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Affiliation(s)
- Karim Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France.
| | - Rémi Delva
- Department of Medical Oncology, Centre Paul Papin, Angers, France
| | - Armelle Caty
- Radiotherapy and Oncology, Centre Galilée, Hôpital Privé La Louvière, Lille, France
| | | | - Pierre Kerbrat
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Frederic Rolland
- Department of Medical Oncology, Centre René Gauducheau, Saint-Herblain, France
| | - Frank Priou
- Service of Internal Medical Onco-Haematology, Hôpital Les Oudairies, La Roche sur Yon, France
| | - Lionnel Geoffrois
- Medical Oncology, Department of Clinical Oncology, Centre Alexis Vautrin, Vandoeuvre lès Nancy, France
| | - Olivier Rixe
- GRU Cancer Center, Department of Hematology Oncology, Augusta, GA, USA
| | | | | | - Stephane Culine
- Department of Medical Oncology, Hôpital Saint-Louis, Paris, France
| | | | - Agnes Laplanche
- Department of Biostatic and Epidemiology, Institut Gustave Roussy, Villejuif, France
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Teo M, McCarthy JE, Brady AP, Curran DR, Power DG. A case of sarcoidosis in a patient with testicular cancer post stem cell transplant. Acta Oncol 2013; 52:869-71. [PMID: 22708529 DOI: 10.3109/0284186x.2012.689854] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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24
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Albers P, Albrecht W, Algaba F, Bokemeyer C, Cohn-Cedermark G, Fizazi K, Horwich A, Laguna M. [EAU guidelines on testicular cancer: 2011 update. European Association of Urology]. Actas Urol Esp 2012; 36:127-45. [PMID: 22188753 DOI: 10.1016/j.acuro.2011.06.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 06/28/2011] [Indexed: 12/31/2022]
Abstract
CONTEXT On behalf of the European Association of Urology (EAU), guidelines for the diagnosis, therapy, and follow-up of testicular cancer were established. OBJECTIVE This article is a short version of the EAU testicular cancer guidelines and summarises the main conclusions from the guidelines on the management of testicular cancer. EVIDENCE ACQUISITION Guidelines were compiled by a multidisciplinary guidelines working group. A systematic review was carried out using Medline and Embase, also taking Cochrane evidence and data from the European Germ Cell Cancer Consensus Group into consideration. A panel of experts weighted the references, and a level of evidence and grade of recommendation were assigned. RESULTS There is a paucity of literature especially regarding longer term follow-up, and results from a number of ongoing trials are awaited. The choice of treatment centre is of the utmost importance, and treatment in reference centres within clinical trials, especially for poor-prognosis nonseminomatous germ cell tumours, provides better outcomes. For patients with clinical stage I seminoma, based on recently published data on long-term toxicity, adjuvant radiotherapy is no longer recommended as first-line adjuvant treatment. The TNM classification 2009 is recommended. CONCLUSIONS These guidelines contain information for the standardised management of patients with testicular cancer based on the latest scientific insights. Cure rates are generally excellent, but because testicular cancer mainly affects men in their third or fourth decade of life, treatment effects on fertility require careful counselling of patients, and treatment must be tailored taking individual circumstances and patient preferences into account. TAKE HOME MESSAGE Although testicular cancer has excellent cure rates, the choice of treatment centre is of the utmost importance. Expert centres achieve better results for both early stage testicular cancer (lower relapse rates) and overall survival (higher stages within clinical trials). For patients with clinical stage I seminoma, adjuvant radiotherapy is no longer recommended as first-line adjuvant treatment.
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Horwich A, Daugaard G, Kollmannsberger C, Beyer J, Jewett MAS. Salvage therapy: SIU/ICUD Consensus Meeting on Germ Cell Tumors (GCT), Shanghai 2009. Urology 2011; 78:S469-74. [PMID: 21986226 DOI: 10.1016/j.urology.2011.03.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 03/08/2011] [Accepted: 03/08/2011] [Indexed: 11/19/2022]
Affiliation(s)
- Alan Horwich
- Department of Clinical Oncology, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, United Kingdom.
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26
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Boujelbene N, Cosinschi A, Boujelbene N, Khanfir K, Bhagwati S, Herrmann E, Mirimanoff RO, Ozsahin M, Zouhair A. Pure seminoma: a review and update. Radiat Oncol 2011; 6:90. [PMID: 21819630 PMCID: PMC3163197 DOI: 10.1186/1748-717x-6-90] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 08/08/2011] [Indexed: 03/27/2023] Open
Abstract
Pure seminoma is a rare pathology of the young adult, often discovered in the early stages. Its prognosis is generally excellent and many therapeutic options are available, especially in stage I tumors. High cure rates can be achieved in several ways: standard treatment with radiotherapy is challenged by surveillance and chemotherapy. Toxicity issues and the patients' preferences should be considered when management decisions are made. This paper describes firstly the management of primary seminoma and its nodal involvement and, secondly, the various therapeutic options according to stage.
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Affiliation(s)
- Noureddine Boujelbene
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Bugnon 46, CH-1011 Lausanne, Switzerland
- Department of Radiation Oncology, Centre Hospitalier Universitaire Habib Bourguiba, 3000 Sfax, Tunisia
- Department of Radiation Oncology, Hôpital de Sion-CHCVs, CH-1950 Sion, Switzerland
| | - Adrien Cosinschi
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Nadia Boujelbene
- Department of Pathology, Institut Gustave-Roussy, 94805 Villejuif, France
- Department of Pathology, Hôpital HabibThameur, 1089 Tunis, Tunisia
| | - Kaouthar Khanfir
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Bugnon 46, CH-1011 Lausanne, Switzerland
- Department of Radiation Oncology, Hôpital de Sion-CHCVs, CH-1950 Sion, Switzerland
| | - Shushila Bhagwati
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Eveleyn Herrmann
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Rene-Olivier Mirimanoff
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Mahmut Ozsahin
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Abderrahim Zouhair
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Bugnon 46, CH-1011 Lausanne, Switzerland
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27
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Koychev D, Oechsle K, Bokemeyer C, Honecker F. Treatment of patients with relapsed and/or cisplatin-refractory metastatic germ cell tumours: an update. ACTA ACUST UNITED AC 2011; 34:e266-73. [DOI: 10.1111/j.1365-2605.2011.01145.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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28
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Salvage Chemotherapy With High-Dose Carboplatin and Etoposide With Peripheral Blood Stem Cell Transplant in Patients With Relapsed Pure Seminoma. Am J Clin Oncol 2011; 34:286-8. [PMID: 20523207 DOI: 10.1097/coc.0b013e3181d6b518] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Abstract
CONTEXT On behalf of the European Association of Urology (EAU), guidelines for the diagnosis, therapy, and follow-up of testicular cancer were established. OBJECTIVE This article is a short version of the EAU testicular cancer guidelines and summarises the main conclusions from the guidelines on the management of testicular cancer. EVIDENCE ACQUISITION Guidelines were compiled by a multidisciplinary guidelines working group. A systematic review was carried out using Medline and Embase, also taking Cochrane evidence and data from the European Germ Cell Cancer Consensus Group into consideration. A panel of experts weighted the references, and a level of evidence and grade of recommendation were assigned. RESULTS There is a paucity of literature especially regarding longer term follow-up, and results from a number of ongoing trials are awaited. The choice of treatment centre is of the utmost importance, and treatment in reference centres within clinical trials, especially for poor-prognosis nonseminomatous germ cell tumours, provides better outcomes. For patients with clinical stage I seminoma, based on recently published data on long-term toxicity, adjuvant radiotherapy is no longer recommended as first-line adjuvant treatment. The TNM classification 2009 is recommended. CONCLUSIONS These guidelines contain information for the standardised management of patients with testicular cancer based on the latest scientific insights. Cure rates are generally excellent, but because testicular cancer mainly affects men in their third or fourth decade of life, treatment effects on fertility require careful counselling of patients, and treatment must be tailored taking individual circumstances and patient preferences into account.
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Abstract
Testicular germ cell tumors and, in particular, seminomas are exquisitely radiation and chemotherapy-sensitive and most presentations are highly curable. In recent years the management focus has been on reducing late sequelae of treatment. For Stage I disease surveillance and adjuvant carboplatin, chemotherapy has become an option. The efficacy of combination chemotherapy has been established for advanced metastatic disease. Through a review of the available literature this article outlines the recent changes in the management of seminoma.
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Affiliation(s)
- Emma J Alexander
- Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, United Kingdom
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31
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Voss MH, Feldman DR, Bosl GJ, Motzer RJ. A review of second-line chemotherapy and prognostic models for disseminated germ cell tumors. Hematol Oncol Clin North Am 2011; 25:557-76, viii -ix. [PMID: 21570609 DOI: 10.1016/j.hoc.2011.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Despite an excellent prognosis even for patients with disseminated disease, about 20% to 30% of men with advanced germ cell tumors are refractory to first-line chemotherapy or experience disease recurrence after an initial remission with such treatment. Many of these are cured with conventional dose cisplatin/ifosfamide-based regimen or high-dose chemotherapy with stem cell rescue. Controversy exists regarding the optimal choice between these 2 second-line approaches, and available data for each is reviewed here. Clinical factors can help prognosticate patients, and recently an international effort developed a prognostic model for the second-line setting that can be universally applied in future studies.
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Affiliation(s)
- Martin H Voss
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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32
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Boujelbene N, Ozsahin M, Khanfir K, Azria D, Mirimanoff RO, Zouhair A. [What's new in the treatment of seminomas?]. Cancer Radiother 2011; 15:208-20. [PMID: 21414829 DOI: 10.1016/j.canrad.2010.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 09/01/2010] [Accepted: 09/30/2010] [Indexed: 10/18/2022]
Abstract
Pure testicular seminoma is a rare disease with an excellent prognosis. Its management is controversial. In stage I disease, several treatment options are considered. Those are radiation therapy alone, chemotherapy alone or active surveillance, which is becoming increasingly popular. For more advanced stages, treatment is based on chemotherapy with or without radiation therapy. In this article, we review thoroughly the existing literature and recent recommendations the various treatment options, their advantages and disadvantages in different stages of the disease.
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Affiliation(s)
- N Boujelbene
- Service de radio-oncologie, CHU vaudois, Lausanne, Suisse
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33
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Aapro MS, Bohlius J, Cameron DA, Dal Lago L, Donnelly JP, Kearney N, Lyman GH, Pettengell R, Tjan-Heijnen VC, Walewski J, Weber DC, Zielinski C. 2010 update of EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphoproliferative disorders and solid tumours. Eur J Cancer 2010; 47:8-32. [PMID: 21095116 DOI: 10.1016/j.ejca.2010.10.013] [Citation(s) in RCA: 743] [Impact Index Per Article: 53.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 10/18/2010] [Indexed: 10/18/2022]
Abstract
Chemotherapy-induced neutropenia is a major risk factor for infection-related morbidity and mortality and also a significant dose-limiting toxicity in cancer treatment. Patients developing severe (grade 3/4) or febrile neutropenia (FN) during chemotherapy frequently receive dose reductions and/or delays to their chemotherapy. This may impact the success of treatment, particularly when treatment intent is either curative or to prolong survival. In Europe, prophylactic treatment with granulocyte-colony stimulating factors (G-CSFs), such as filgrastim (including approved biosimilars), lenograstim or pegfilgrastim is available to reduce the risk of chemotherapy-induced neutropenia. However, the use of G-CSF prophylactic treatment varies widely in clinical practice, both in the timing of therapy and in the patients to whom it is offered. The need for generally applicable, European-focused guidelines led to the formation of a European Guidelines Working Party by the European Organisation for Research and Treatment of Cancer (EORTC) and the publication in 2006 of guidelines for the use of G-CSF in adult cancer patients at risk of chemotherapy-induced FN. A new systematic literature review has been undertaken to ensure that recommendations are current and provide guidance on clinical practice in Europe. We recommend that patient-related adverse risk factors, such as elderly age (≥65 years) and neutrophil count be evaluated in the overall assessment of FN risk before administering each cycle of chemotherapy. It is important that after a previous episode of FN, patients receive prophylactic administration of G-CSF in subsequent cycles. We provide an expanded list of common chemotherapy regimens considered to have a high (≥20%) or intermediate (10-20%) risk of FN. Prophylactic G-CSF continues to be recommended in patients receiving a chemotherapy regimen with high risk of FN. When using a chemotherapy regimen associated with FN in 10-20% of patients, particular attention should be given to patient-related risk factors that may increase the overall risk of FN. In situations where dose-dense or dose-intense chemotherapy strategies have survival benefits, prophylactic G-CSF support is recommended. Similarly, if reductions in chemotherapy dose intensity or density are known to be associated with a poor prognosis, primary G-CSF prophylaxis may be used to maintain chemotherapy. Clinical evidence shows that filgrastim, lenograstim and pegfilgrastim have clinical efficacy and we recommend the use of any of these agents to prevent FN and FN-related complications where indicated. Filgrastim biosimilars are also approved for use in Europe. While other forms of G-CSF, including biosimilars, are administered by a course of daily injections, pegfilgrastim allows once-per-cycle administration. Choice of formulation remains a matter for individual clinical judgement. Evidence from multiple low level studies derived from audit data and clinical practice suggests that some patients receive suboptimal daily G-CSFs; the use of pegfilgrastim may avoid this problem.
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Affiliation(s)
- M S Aapro
- Multidisciplinary Oncology Institute, Clinique de Genolier, 1, route du Muids, 1272 Genolier, Switzerland.
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Durand X, Rigaud J, Avances C, Camparo P, Culine S, Iborra F, Mottet N, Sèbe P, Soulié M. Recommandations en Onco-Urologie 2010 : Tumeurs germinales du testicule. Prog Urol 2010; 20 Suppl 4:S297-309. [DOI: 10.1016/s1166-7087(10)70046-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Som A, Zhu R, Guo CC, Efstathiou E, Xiao L, Pisters LL, Matin A, Tu SM. Recurrent seminomas: clinical features and biologic implications. Urol Oncol 2010; 30:494-501. [PMID: 20822932 DOI: 10.1016/j.urolonc.2010.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 05/19/2010] [Accepted: 05/21/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Certain patients with seminoma and clinically atypical phenotypes--visceral metastases, elevated levels of β human chorionic gonadotropin (βHCG), and/or recurrent disease--have a poor prognosis. The primary goal of this pilot study was to characterize the clinical characteristics and treatment profile of these rare patients. We also wished to test whether these tumors expressed any specific biomarkers that might distinguish them as a unique subtype of seminoma. MATERIALS AND METHODS We retrospectively identified 25 patients with a history of seminoma plus visceral metastases, βHCG levels >200 mU/ml, and/or recurrent disease. We reviewed these patients' histories for treatment efficacy and clinical outcome. Tissue samples were available from 6 of those patients, and we studied them for expression of the markers OCT 3/4, PLAP, CD30, TRA-1-60, c-kit, and gp200. We compared our results with the expression of those markers in tissue samples from mixed seminoma/embryonal carcinomas and classic seminomas. RESULTS Our analysis suggested that certain chemotherapeutic regimens (such as ifosfamide, paclitaxel, and cisplatin) are efficacious for the treatment of patients with these atypical seminomas. Further, specimens from the atypical seminomas generally had staining profiles that resembled those of classic seminomas and the seminoma components in mixed germ-cell tumors, but the profiles differed from those of the embryonal carcinoma components in the same mixed germ-cell tumors. CONCLUSIONS Although these atypical seminomas tend to be resistant to chemotherapy, they may still respond to certain chemotherapeutic regimens. Our pilot immunohistochemical study also suggested that the unique phenotypes associated with these atypical seminomas do not result from any relationship with embryonal carcinomas. More study is needed to confirm these initial findings.
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Affiliation(s)
- Avik Som
- Department of Genitourinary Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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Elevated LDH predicts poor outcome of recurrent germ cell tumours treated with dose dense chemotherapy. Eur J Cancer 2010; 46:2913-8. [PMID: 20709529 DOI: 10.1016/j.ejca.2010.07.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Accepted: 07/07/2010] [Indexed: 11/24/2022]
Abstract
AIMS OF THE STUDY Prognostic factors for recurrent germ cell tumours (GCTs) treated with dose dense salvage chemotherapy have not been identified. This study determines whether lactate dehydrogenase (LDH) or established prognostic models can predict the outcome of recurrent GCTs treated with dose dense cisplatin-based chemotherapy. PATIENTS AND METHODS Retrospective analysis of 117 consecutive male patients with a first recurrence of a GCT treated with dose dense chemotherapy at a single cancer centre. Characteristics associated with progression-free survival (PFS) and overall survival (OS) were identified by univariate and multivariate analyses. Prognostic criteria published by the Medical Research Council (MRC) and the Memorial Sloan Kettering Cancer Centre (MSK) were also applied in an attempt to validate them and to compare their performance to that of LDH. RESULTS Raised LDH was significantly associated with poor PFS (hazard ratio (HR)=3.7; p<0.001) and OS (HR=3.4; p=0.001). Further factors associated with poor PFS and OS, respectively, were failure to achieve a complete response or marker negative partial response for at least 6 months (HR=2.1; p=0.033) and seminoma histology (HR=3.4; p=0.003). The MRC prognostic model, but not the MSK model, identified groups of patients with statistically significant differences in PFS and OS but raised LDH predicted OS and PFS with a higher HR. CONCLUSIONS Raised LDH is associated with a poor prognosis in recurrent GCTs and outperforms established prognostic models in this setting. LDH as a prognostic factor should be validated prospectively and should also be assessed in patients receiving conventional dose chemotherapy regimens.
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Gilligan TD, Seidenfeld J, Basch EM, Einhorn LH, Fancher T, Smith DC, Stephenson AJ, Vaughn DJ, Cosby R, Hayes DF. American Society of Clinical Oncology Clinical Practice Guideline on Uses of Serum Tumor Markers in Adult Males With Germ Cell Tumors. J Clin Oncol 2010; 28:3388-404. [DOI: 10.1200/jco.2009.26.4481] [Citation(s) in RCA: 192] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PurposeTo provide recommendations on appropriate uses for serum markers of germ cell tumors (GCTs).MethodsSearches of MEDLINE and EMBASE identified relevant studies published in English. Primary outcomes included marker accuracy to predict the impact of decisions on outcomes. Secondary outcomes included proportions of patients with elevated markers and statistical tests of elevations as prognostic factors. An expert panel developed consensus guidelines based on data from 82 reports.ResultsNo studies directly compared outcomes of decisions with versus without marker assays. The search identified few prospective studies and no randomized controlled trials; most were retrospective series. Lacking data on primary outcomes, most Panel recommendations are based on secondary outcomes (relapse rates and time to relapse).RecommendationsThe Panel recommended against using markers to screen for GCTs, to decide whether orchiectomy is indicated, or to select treatment for patients with cancer of unknown primary. To stage patients with testicular nonseminomas, the Panel recommended measuring three markers (α-fetoprotein [AFP], human chorionic gonadotropin [hCG], and lactate dehydrogenase [LDH]) before and after orchiectomy and before chemotherapy for those with extragonadal nonseminomas. They also recommended measuring AFP and hCG shortly before retroperitoneal lymph node dissection and at the start of each chemotherapy cycle for nonseminoma, and periodically to monitor for relapse. The Panel recommended measuring postorchiectomy hCG and LDH for patients with seminoma and preorchiectomy elevations. They recommended against using markers to guide or monitor treatment for seminoma or to detect relapse in those treated for stage I. However, they recommended measuring hCG and AFP to monitor for relapse in patients treated for advanced seminoma.
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Affiliation(s)
- Timothy D. Gilligan
- From the Taussig Cancer Institute and the Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; American Society of Clinical Oncology, Alexandria, VA; Memorial Sloan-Kettering Cancer Center, New York, NY; Indiana Cancer Pavilion, Indiana University, Indianapolis, IN; Patient Representative; University of Michigan Medical Center, Ann Arbor, MI; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; and Cancer Care Ontario, McMaster University, Hamilton, Ontario,
| | - Jerome Seidenfeld
- From the Taussig Cancer Institute and the Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; American Society of Clinical Oncology, Alexandria, VA; Memorial Sloan-Kettering Cancer Center, New York, NY; Indiana Cancer Pavilion, Indiana University, Indianapolis, IN; Patient Representative; University of Michigan Medical Center, Ann Arbor, MI; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; and Cancer Care Ontario, McMaster University, Hamilton, Ontario,
| | - Ethan M. Basch
- From the Taussig Cancer Institute and the Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; American Society of Clinical Oncology, Alexandria, VA; Memorial Sloan-Kettering Cancer Center, New York, NY; Indiana Cancer Pavilion, Indiana University, Indianapolis, IN; Patient Representative; University of Michigan Medical Center, Ann Arbor, MI; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; and Cancer Care Ontario, McMaster University, Hamilton, Ontario,
| | - Lawrence H. Einhorn
- From the Taussig Cancer Institute and the Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; American Society of Clinical Oncology, Alexandria, VA; Memorial Sloan-Kettering Cancer Center, New York, NY; Indiana Cancer Pavilion, Indiana University, Indianapolis, IN; Patient Representative; University of Michigan Medical Center, Ann Arbor, MI; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; and Cancer Care Ontario, McMaster University, Hamilton, Ontario,
| | - Timothy Fancher
- From the Taussig Cancer Institute and the Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; American Society of Clinical Oncology, Alexandria, VA; Memorial Sloan-Kettering Cancer Center, New York, NY; Indiana Cancer Pavilion, Indiana University, Indianapolis, IN; Patient Representative; University of Michigan Medical Center, Ann Arbor, MI; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; and Cancer Care Ontario, McMaster University, Hamilton, Ontario,
| | - David C. Smith
- From the Taussig Cancer Institute and the Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; American Society of Clinical Oncology, Alexandria, VA; Memorial Sloan-Kettering Cancer Center, New York, NY; Indiana Cancer Pavilion, Indiana University, Indianapolis, IN; Patient Representative; University of Michigan Medical Center, Ann Arbor, MI; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; and Cancer Care Ontario, McMaster University, Hamilton, Ontario,
| | - Andrew J. Stephenson
- From the Taussig Cancer Institute and the Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; American Society of Clinical Oncology, Alexandria, VA; Memorial Sloan-Kettering Cancer Center, New York, NY; Indiana Cancer Pavilion, Indiana University, Indianapolis, IN; Patient Representative; University of Michigan Medical Center, Ann Arbor, MI; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; and Cancer Care Ontario, McMaster University, Hamilton, Ontario,
| | - David J. Vaughn
- From the Taussig Cancer Institute and the Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; American Society of Clinical Oncology, Alexandria, VA; Memorial Sloan-Kettering Cancer Center, New York, NY; Indiana Cancer Pavilion, Indiana University, Indianapolis, IN; Patient Representative; University of Michigan Medical Center, Ann Arbor, MI; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; and Cancer Care Ontario, McMaster University, Hamilton, Ontario,
| | - Roxanne Cosby
- From the Taussig Cancer Institute and the Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; American Society of Clinical Oncology, Alexandria, VA; Memorial Sloan-Kettering Cancer Center, New York, NY; Indiana Cancer Pavilion, Indiana University, Indianapolis, IN; Patient Representative; University of Michigan Medical Center, Ann Arbor, MI; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; and Cancer Care Ontario, McMaster University, Hamilton, Ontario,
| | - Daniel F. Hayes
- From the Taussig Cancer Institute and the Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; American Society of Clinical Oncology, Alexandria, VA; Memorial Sloan-Kettering Cancer Center, New York, NY; Indiana Cancer Pavilion, Indiana University, Indianapolis, IN; Patient Representative; University of Michigan Medical Center, Ann Arbor, MI; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; and Cancer Care Ontario, McMaster University, Hamilton, Ontario,
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Lin CK, Liu HT. Evidence-based treatment for advanced germ cell tumor of the testis with a case illustration. J Chin Med Assoc 2010; 73:343-52. [PMID: 20688298 DOI: 10.1016/s1726-4901(10)70075-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Accepted: 06/11/2010] [Indexed: 11/16/2022] Open
Abstract
Testicular germ cell tumor is rare in the Asian population. Nevertheless, it is a prototypic cancer of young adults because it can be highly malignant but is also highly curable, even at an advanced stage. We present a case with far-advanced embryonal carcinoma, treated with bleomycin, etoposide and platinum (BEP) x 4 cycles. This case has shown very good results from the treatment. This is the standard therapy for poor- and intermediate-risk patients with germ cell tumors in the advanced stage, supported by current evidence-based literature. BEP x 3 cycles or EP x 4 cycles is the standard therapy for good-risk patients with advanced germ cell tumors. Using these treatments, we can achieve durable remissions of approximately 90%, 75%, and 45% in good-, intermediate-, and poor-risk patients, respectively. However, the physical and psychological long-term outcomes should be carefully monitored.
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Affiliation(s)
- Chung-King Lin
- Cathay General Hospital, Taipei Medical University, Taiwan, R.O.C.
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39
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Durand X, Avances C, Flechon A, Mottet N. Récidives tardives des tumeurs germinales du testicule. Prog Urol 2010; 20:416-24. [DOI: 10.1016/j.purol.2010.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 10/02/2009] [Accepted: 02/09/2010] [Indexed: 12/01/2022]
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40
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Wood L, Kollmannsberger C, Jewett M, Chung P, Hotte S, O'Malley M, Sweet J, Anson-Cartwright L, Winquist E, North S, Tyldesley S, Sturgeon J, Gospodarowicz M, Segal R, Cheng T, Venner P, Moore M, Albers P, Huddart R, Nichols C, Warde P. Canadian consensus guidelines for the management of testicular germ cell cancer. Can Urol Assoc J 2010; 4:e19-38. [PMID: 20368885 PMCID: PMC2845668 DOI: 10.5489/cuaj.815] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Lori Wood
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, NS
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41
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Chetaille B, Massard G, Falcoz PE. [Mediastinal germ cell tumors: anatomopathology, classification, teratomas and malignant tumors]. REVUE DE PNEUMOLOGIE CLINIQUE 2010; 66:63-70. [PMID: 20207298 DOI: 10.1016/j.pneumo.2009.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 12/17/2009] [Indexed: 05/12/2023]
Abstract
Mediastinal germ cell tumors are rare tumors. It is classic to divide those tumors into two categories, seminomas and nonseminomatous germ cell tumors: teratomas (mature or immature), embryonal carcinomas, yolk sac tumors, and choriocarcinomas. Each histological sub-type can be associated to another sub-type that realise a so-called mixed germ cell tumor. Diagnosis strategy is currently well codified for malignant mediastinal germ cell tumors. It greatly benefits from tumoral markers (alpha-fetoprotein and beta human chorionic gonadotrophin). For instance, the treatment strategy still raises some specific problems to each histological type. The treatment of seminomatous tumors is standardised--chemotherapy/surgery on residual tumor greater than 3 cm/radiotherapy on viable persistent residual tumors--and provides very satisfying results. As for the nonseminomatous germ cell tumors, the situation is dramatically different. The treatment strategy is less standardised--association of chemotherapy and surgery--and the prognosis is very severe.
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Affiliation(s)
- B Chetaille
- Département de Biopathologie, Institut Paoli-Calmettes, 232 Boulevard Sainte- Marguerite, BP 156, 13272 Marseille cedex 9, France
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42
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Cisplatin-based chemotherapy for advanced seminoma: report of 52 cases treated in two institutions. J Cancer Res Clin Oncol 2009; 135:1495-500. [DOI: 10.1007/s00432-009-0596-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2009] [Accepted: 04/22/2009] [Indexed: 11/26/2022]
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43
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[Salvage treatment in germ cell tumors : high-dose chemotherapy and the impact of prognostic factors]. Urologe A 2009; 48:364-71. [PMID: 19255738 DOI: 10.1007/s00120-009-1947-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The majority of patients with germ cell tumors who fail first-line treatment will still be cured. Patients without first-line chemotherapy who fail surveillance, radiotherapy, or surgery will be managed according to the treatment algorithms of their primary metastatic disease. These patients usually receive three to four cycles of cisplatin, etoposide, and bleomycin.Salvage treatment of patients who relapse after first-line chemotherapy is more complex and requires an experienced and highly specialized team. Two distinct treatment strategies can be pursued: four cycles of conventional-dose chemotherapy with cisplatin, ifosfamide, and either etoposide, paclitaxel, or vinblastine; or early intensification of first-salvage treatment using sequential high-dose chemotherapy. Salvage surgery is frequently required after completion of salvage chemotherapy to completely resect all radiologic residual manifestations. Patients with brain metastases should receive upfront whole brain radiation concurrent with salvage chemotherapy. Patients with late relapses more than 2 years after first-line treatment should receive immediate salvage surgery whenever this is technically feasible.
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Kollmannsberger C, Honecker F, Bokemeyer C. Pharmacotherapy of relapsed metastatic testicular cancer. Expert Opin Pharmacother 2008; 9:2259-72. [DOI: 10.1517/14656566.9.13.2259] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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45
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Salvage chemotherapy after failure of first-line chemotherapy in patients with metastatic testicular cancer. Curr Opin Support Palliat Care 2008; 2:167-72. [PMID: 18685416 DOI: 10.1097/spc.0b013e328309c741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Because of the small number of relapsed patients, their prognostic variability and the complexity of second-line therapy, randomized studies are largely lacking and treatment recommendations for patients with relapse after first-line chemotherapy are derived from retrospective series or phase II studies. This review summarizes the existing evidence including several recently published larger studies on the use of high-dose chemotherapy in these patients. RECENT FINDINGS Patients with unfavorable features such as incomplete response to first-line therapy, cisplatin refractoriness, multiple relapses or advanced stage at initial diagnosis have been shown to benefit from salvage high-dose chemotherapy with autologous stem cell support. Long-term survival rates of up to 60% have been reported after salvage high-dose chemotherapy for these patients. The treatment for patients relapsing after complete remission to first-line therapy, cisplatin-sensitive disease and gonadal primary remains controversial. Excellent long-term event-free survival rates of up to 80% have been reported after both conventional and high-dose chemotherapy. Surgery remains an important part of any salvage strategy. SUMMARY The prognosis of patients relapsing after first-line cisplatin-based chemotherapy has improved with multimodality therapy including conventional and high-dose chemotherapy, surgery and radiation. The treatment of these patients requires a close cooperation of experienced medical oncologists, urologists and radiation oncologists.
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Krege S, Beyer J, Souchon R, Albers P, Albrecht W, Algaba F, Bamberg M, Bodrogi I, Bokemeyer C, Cavallin-Ståhl E, Classen J, Clemm C, Cohn-Cedermark G, Culine S, Daugaard G, De Mulder PH, De Santis M, de Wit M, de Wit R, Derigs HG, Dieckmann KP, Dieing A, Droz JP, Fenner M, Fizazi K, Flechon A, Fosså SD, Garcia del Muro X, Gauler T, Geczi L, Gerl A, Germa-Lluch JR, Gillessen S, Hartmann JT, Hartmann M, Heidenreich A, Hoeltl W, Horwich A, Huddart R, Jewett M, Joffe J, Jones WG, Kisbenedek L, Klepp O, Kliesch S, Koehrmann KU, Kollmannsberger C, Kuczyk M, Laguna P, Leiva Galvis O, Loy V, Mason MD, Mead GM, Mueller R, Nichols C, Nicolai N, Oliver T, Ondrus D, Oosterhof GO, Paz-Ares L, Pizzocaro G, Pont J, Pottek T, Powles T, Rick O, Rosti G, Salvioni R, Scheiderbauer J, Schmelz HU, Schmidberger H, Schmoll HJ, Schrader M, Sedlmayer F, Skakkebaek NE, Sohaib A, Tjulandin S, Warde P, Weinknecht S, Weissbach L, Wittekind C, Winter E, Wood L, von der Maase H. European Consensus Conference on Diagnosis and Treatment of Germ Cell Cancer: A Report of the Second Meeting of the European Germ Cell Cancer Consensus Group (EGCCCG): Part II. Eur Urol 2008; 53:497-513. [PMID: 18191015 DOI: 10.1016/j.eururo.2007.12.025] [Citation(s) in RCA: 190] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Accepted: 12/06/2007] [Indexed: 10/22/2022]
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Detti B, Elliott PA, McLaren DB, Howard GCW. Late Relapse and Follow-up Protocols in Testicular Germ Cell Tumours: The Edinburgh Cancer Centre Experience and Review of the Literature. Clin Med Oncol 2008; 2:19-25. [PMID: 21892262 PMCID: PMC3161629 DOI: 10.4137/cmo.s321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS To identify clinicopathological features and outcomes in patients with late relapse (LR) of testicular germ cell tumours (GCTs) in order to guide follow-up policy. MATERIALS AND METHODS The Edinburgh Cancer Centre (ECC) database identified all patients diagnosed with testicular GCT between 1988 and 2002. Of 703 patients, six relapsed more than 24 months after their initial treatment. A retrospective casenote review was performed to extract clinical, pathological, treatment and outcome data. RESULTS Six patients (0.85%) underwent late relapse. All patients presented initially with stage I disease and five were classified as good risk (International Germ Cell Consensus Classification, IGCCC). Median time to LR was 31 months. Two patients had previously relapsed less than 24 months from initial diagnosis. Markers at the time of relapse were normal in all patients. In all cases of late relapse disease was confined to axial lymphadenopathy. Three patients were treated with chemotherapy alone, two patients underwent surgical resection and one patient received combined treatment. All patients obtained a complete response and all remain disease free with a median follow-up of 52 months. CONCLUSIONS The incidence of late relapse in this series is low. Chemo-naive patients with LR were successfully salvaged with chemotherapy alone and patients previously exposed to cisplatin-based chemotherapy were salvaged with complete surgical excision. The optimal length of follow-up in patients with testicular germ cell tumours is not known and practice varies widely. In this cohort of 703 patients, only one patient who relapsed was picked up by additional clinic follow-up between 5 and 10 years. Thus, on the basis of this small series, the authors suggest that follow-up after five years may not be justified.
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Affiliation(s)
- Beatrice Detti
- Department of Radiotherapy, University of Florence, Florence, Italy
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48
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Gilligan T, Kantoff PW. Testis Cancer. Oncology 2007. [DOI: 10.1007/0-387-31056-8_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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vom Dorp F, Krege S, Rübben H. [Inductive systemic therapy of urological tumors with curative intent]. Urologe A 2007; 46:1400-3. [PMID: 17874061 DOI: 10.1007/s00120-007-1539-7] [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: 10/22/2022]
Abstract
Up to now systemic therapy with curative intent is possible in only a few tumors. Concerning advanced malignant tumors in urology only testicular cancer can be cured. In metastatic urothelial cancer of the bladder this might be possible in single cases. In advanced renal cell carcinoma a recent group of new substances, so-called target-specific substances, have gained attention. In several phase III studies with sunitinib, sorafenib, and temsirolimus at least progression-free survival could be clearly prolonged. The amazing results in testicular cancer were possible by consistent performance of clinical trials. The success in treatment also is an example for interdisciplinarity. Especially in advanced stages treatment consists of two components, chemotherapy, correctly performed concerning dose and interval, followed by complete residual tumor resection.
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Affiliation(s)
- F vom Dorp
- Urologische Universitätsklinik, 45122 Essen.
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50
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Detti B, Livi L, Scoccianti S, Meattini I, Gacci M, Lapini A, Biti G. Late Relapse in Testicular Germ Cell Tumors. TUMORI JOURNAL 2007; 93:428-31. [DOI: 10.1177/030089160709300504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background Analysis of patients with late relapse of testicular germ cell tumors (GCTs) with reports on clinicopathological features and outcomes. Methods We identified all patients diagnosed with testicular GCTs at our Institute between 1988 and 2004 who developed relapse ≥24 months after completion of primary therapy. A retrospective case-note review was performed to extract clinical, pathological, treatment and outcome data. Results Six patients (1.25%) developed late relapse. All patients presented with stage I disease and were classified as “good risk” according to the International Germ Cell Consensus Classification. Mean time to late relapse was 48 months. Markers at late relapse were normal in all patients. Relapse was confined to retroperitoneal sites in five patients and located in the mediastinum in one patient. Five patients were managed by chemotherapy alone while one underwent combined treatment with surgery followed by chemotherapy. All patients obtained a complete response and all remained free from recurrence with a mean follow-up of 115 months. Conclusions The incidence of late relapse in this small series is low. Chemonaive patients with late relapse were successfully salvaged with chemotherapy alone or surgical excision followed by cisplatin-based chemotherapy. The optimal duration of follow-up in patients with testicular GCTs is not known and practice varies widely. At our Institute we advise lifelong follow-up of all patients with malignant GCTs of the testis.
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Affiliation(s)
- Beatrice Detti
- Institute of Radiotherapy, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Institute of Radiotherapy, University of Florence, Florence, Italy
| | | | - Icro Meattini
- Institute of Radiotherapy, University of Florence, Florence, Italy
| | - Mauro Gacci
- Department of Urology, University of Florence, Florence, Italy
| | - Alberto Lapini
- Department of Urology, University of Florence, Florence, Italy
| | - Giampaolo Biti
- Institute of Radiotherapy, University of Florence, Florence, Italy
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