High-dose chemotherapy with stem cell transplant cures most relapsed testis cancer cases
INDIANAPOLIS – Sixty percent of men whose testicular cancer returned were cured with high-dose chemotherapy and a stem cell transplant, according to research published by Indiana University researchers.
Researchers, led by Lawrence Einhorn, MD, IU Distinguished Professor and Livestrong Foundation Professor of Oncology at the IU School of Medicine and a researcher at the Indiana University Melvin and Bren Simon Cancer Center, found that high-dose chemotherapy with carboplatin and etoposide followed by a stem cell transplant using the patients' own peripheral blood stem cells cured 60 percent of the men, even those with aggressive and advanced disease.
The research was published online in the Journal of Clinical Oncology.
"Our study shows that high-dose chemotherapy and autologous peripheral-blood stem cell transplant is very effective at curing patients with relapsed testicular cancer," Dr. Einhorn and colleagues wrote.
The researchers studied 364 patients who relapsed after receiving an initial round of chemotherapy and were then treated with high-dose chemotherapy and transplant between 2004 and 2014. It is believed to be the largest single-institution study that evaluated high-dose chemotherapy and peripheral-blood stem cell transplant in patients with relapsed testicular cancer.
The research team pointed out that there is uncertainty regarding the best treatment options for men who relapse. The choices are surgery, standard-dose cisplatin combination chemotherapy, or high-dose chemotherapy.
This study's findings not only demonstrated that a significant proportion of men were cured, but the combination of high-dose chemotherapy and peripheral-blood stem cell transplant was also well tolerated by the men and it had low treatment-related mortality.
"Our study demonstrates that patients with metastatic testicular cancer who were not cured with initial chemotherapy can still be cured with high-dose chemotherapy and peripheral-blood stem cell transplant for two consecutive courses," said first author Nabil Adra, MD. "In addition, this treatment was tolerated by most patients.
"Using high-dose chemotherapy, we were able to cure patients with testicular cancer who had very aggressive and advanced disease, such as cancer that had spread to the brain, who would otherwise be very difficult to cure with standard chemotherapy regimens. It's a very effective therapy and should be considered in patients with testicular cancer who are not cured with initial chemotherapy," Dr. Adra added.
Testicular cancer is the most common cancer among men ages 15 to 35. In 1974, Dr. Einhorn tested the platinum-based drug Cisplatin with two additional drugs that were effective in killing testis cancer cells. The combination became the cure for this once deadly disease.
Today, more than 95 percent of all patients with this disease now survive. The survival rate for testicular patients who develop metastatic disease is now more than 80 percent, up from 10 percent before Dr. Einhorn’s revolutionary therapy.
The study was made possible, in part, by the National Cancer Institute (1RO1CA157823).
Other authors included IU Simon Cancer Center researchers Nasser Hanna, MD; Costantine Albany, MD; and Rafat Abonour, MD. IU School of Medicine biostatistician Sandra Althouse, M.S., also contributed.
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