Recent strategy for the management of advanced testicular cancer

Abstract

Testicular cancer is the most common cancer in young men and the cure rate has been approximately 80% since the introduction of cisplatin in the 1970s. BEP therapy (including bleomycin, etoposide and cisplatin) has become a standard induction therapy instead of PVB therapy (cisplatin, vinblastin and bleomycin). However, the patients with incomplete responses to cisplatin-based first-line therapy or with relapsed disease have an extremely poor prognosis. For such difficult-to-treat patients, there are some proposed treatment options such as ifosfamide-containing salvage chemotherapy or high-dose chemotherapy (HDCT). HDCT with bone marrow rescue has been carried out as salvage or induction chemotherapy. However, a randomized control trial did not show the superiority to conventional first line therapy or salvage therapy. Therefore, a new anticancer agent was tested for cisplatin-refractory or resistant testicular cancer. The development of combination therapy with new anticancer agents such as paclitaxel and irinotecan seems to be effective for these patients. TIP therapy including paclitaxel, ifosfamide and cisplatin would be a standard second line therapy for the patients with BEP failure. Residual tumor resection including retroperitoneal lymph node dissection integrated with induction and salvage chemotherapy still remains to play an important role to achieving a cure for advanced testicular cancer because there is no modality to predict residual viable cancer cells or teratoma element in the residual tumors. In the present review, we discuss and focus on the recent treatment strategy of advanced testicular cancer.

Anticancer Activity of a Combination of Cisplatin and Fisetin in Embryonal Carcinoma Cells and Xenograft Tumors

“…A percentage of these carcinomas originating from germ cells either do not respond to treatment or recur post chemotherapy (2,3). Testicular teratocarcinomas and embryonal carcinoma cells derived from these tumors are extremely sensitive to cisplatin [cis-diamminedichloroplatinum (II)] and its derivatives (4)(5)(6); however, use of high doses of cisplatin is limited by the occurrence of various side effects (7,8). Combination regimens with cisplatin have been tried with moderate success; however, the search continues for improved formulations (9,10).…”

Late recurrence of an embryonal carcinoma of the testis. Case report

“…The option of primary nerve-sparing RPLND (followed by active surveillance for pN0, or by adjuvant chemotherapy for most pN+ cases) is available for highly selected cases, unable/not willing to undergo primary chemotherapy. With either approach, cure rates should be as high as 98% [3,4]. The highest rates of recurrence are seen in the first two years, but distant relapses may occur (with lower frequency) for up to 5 years, so rigorous follow-up is warranted at least for this interval (lifelong monitoring has also been advocated).…”

“…In case of relapse, favorable prognosis is predicted by complete resection (< 10% viable malignant cells), a good IGCCCG score at presentation, and possibly a longer platinumfree interval [3,4,7,[13][14][15][16]. Multimodality salvage therapy (conventional-dose chemotherapy and surgery) is still expected to cure approximately 25% of relapsed NSGCTs and ensure long-term remissions in 50% of patients [3].…”

“…Dependent on tumor stage and prognosis (good, intermediate or poor), surveillance, chemotherapy (usually BEP protocol) or/and nerve-sparing retroperitoneal lymph node dissection (RPLND) are recommended for early stage NSGCT, while the standard treatment for recurrent and/or metastatic tumors is multiagent platinum-based chemotherapy (Cisplatin, Ifosfamide, Etoposide or Paclitaxel), with an overall cure rate of around 80% [3,4,5]. The vast majority of relapses occur in the first two years since diagnosis of the advanced disease.…”

Oncological Outcomes of Metastatic Testicular Cancers under Centralized Management through Regional Medical Network

“…In recent decades, the outcome of treatment of advanced testicular cancer patients has been improved (1,2). Multiple factors, including the wide use of first-line therapy with bleomycin, etoposide and cisplatin (BEP), introduction of intensified salvage chemotherapy and appropriate surgical intervention, are supposed to be responsible for this progress (1,2).…”