Cure for metastatic testicular cancer

Testicular cancer patients who do not respond to traditional therapy can be cured with high-dose chemotherapy and stem cells, says a U.S. study. About 90 percent of testicular cancer patients respond to traditional therapy, which involves multiple courses of cisplatin, first used successfully in the treatment of this disease by Dr. Lawrence Einhorn at Indiana University Cancer Center in the early 1980s.

The review looks at the outcome of 184 patients with metastatic testicular cancer who received carboplatin chemotherapy at five times the dosage administered to men receiving initial therapy. A side effect of the high dosage is a reduction of blood cells, so a stem cell transplant is given to replenish the body's immune system through a process similar to a blood transfusion. Three to four weeks later the entire process is repeated, according to study leader Einhorn.

The study, published in the New England Journal of Medicine, demonstrated that the disease is potentially curable with a high dose of chemotherapy and stem cell transplant using cells harvested from the patient before the initial chemotherapy infusion.

Recurrent Testicular Cancer Potentially Curable with High-dose Therapy and Stem Cell Transplant

According to an article recently published in the New England Journal of Medicine, metastatic testicular cancer that has recurred following standard therapy can potentially be cured with high-dose therapy and an autologous stem cell transplant. Cancer of the testicles is the most common cancer in men 15 to 34 years old. The testicles are part of the male reproductive system and are located inside the scrotum (a loose sac of skin that lies directly under the penis). Sperm and male hormones are produced in the testicles. Metastatic testicular cancer refers to cancer that has spread from the testicles to distant sites in the body.

Standard treatment for metastatic testicular cancer typically involves the surgical removal of the testicle that has cancer, as well as cancerous areas in other sites of the body. In addition, patients may often receive chemotherapy containing a platinum-based agent (Platinol® or Paraplatin®) with or without radiation therapy. Some patients who experience a disappearance of their cancer with initial therapy may experience a recurrence of their cancer. As well, some patients do not respond to initial therapy. High-dose therapy and an autologous stem cell transplant are components of a treatment procedure in which higher than normal doses of therapy are used. The high doses tend to kill more cancer cells, but they also tend to kill more healthy cells, resulting in severe side effects. A common side effect is low levels of blood cells, including low levels of red blood cells, immune cells, and platelets. Severely low levels of these cells may result in anemia, bleeding, and infection, all of which may become life-threatening without medical intervention. In an effort to control these side effects, hematopoietic stem cells—immature blood cells that will mature into red blood cells, immune cells, or platelets—are collected from the patient prior to therapy, frozen, and infused following therapy. These stem cells restore the levels of the blood cells that have been depleted through high-dose therapy.

Researchers from Indiana recently conducted a clinical study to evaluate the effectiveness of high-dose therapy and an autologous stem cell transplant among patients with recurrent testicular cancer. This study included 184 patients who had received prior Platinol-based therapy; 49 of whom had received two prior therapies and 40 of whom did not respond to initial Platinol-based therapy. The following results are at a four-year follow-up after high-dose therapy and stem cell transplantation:

Overall, 63% of patients had no evidence of detectable cancer.
70% of patients who had only received one prior therapy remained cancer-free, compared with 45% of those who had received at least two prior therapies.
Three patients died from treatment-related complications.

The researchers concluded that patients with metastatic testicular cancer whose cancer recurs following initial therapy may potentially be cured with high-dose therapy plus an autologous stem cell transplant. Patients with metastatic testicular cancer that has recurred may wish to speak with their physician regarding their individual risks and benefits of this treatment procedure.

Reference: Einhorn L, Williams S, Chamness a, et al. High-dose chemotherapy and stem-cell rescue for metastatic germ-cell tumors. New England Journal of Medicine. 2007;357:340-348.

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