High dose chemotherapy effective in patients with recurrent testicular cancer

High-dose chemotherapy followed by stem-cell transplantation offers new hope to testicular cancer patients who experience cancer recurrence. For these patients, such intensive therapy can achieve a durable remission in approximately 50% of patients, according to a study conducted at Indiana University Medical Center.

In the largest study to date, after an average of more than three years of follow-up, 37 (or 57%) of 65 patients with recurrent testicular cancer were disease-free after receiving two rounds of high-dose chemotherapy followed by stem-cell transplantation. These results are significant says the study’s lead author, Lawrence H. Einhorn, M.D., because if testicular cancer recurs, it often develops within a year after treatment. All patients in this study had a minimal follow-up of 16 months.

Researchers say the advance is remarkable because it demonstrates how the battle against testicular cancer is being won. Already, 70% of patients are cured with initial chemotherapy. This study shows that for the remaining 30% of patients who did not respond to the treatment or who later relapsed, more than half can be cured with a second round of intensive chemotherapy – bringing the overall cure rate to approximately 85 percent.

“This is a message of hope,” says Dr. Einhorn. “For patients who are not cured with the initial chemotherapy, we can now tell them with confidence that there is more than a 50% chance they can still be cured with second-line therapy.”

Historically, high-dose chemotherapy was viewed as a treatment of last resort for testicular cancer because of its toxicity, especially when combined with bone marrow transplants. But with the more recent ability to extract stem cells from the blood, not the marrow, effectiveness has increased, the severity of side effects has decreased, and the financial cost has lessened. The majority of this therapy is currently conducted in the outpatient unit.

“High-Dose Chemotherapy as Initial Salvage Chemotherapy in Patients With Relapsed Testicular Cancer;” Lawrence H. Einhorn, MD, et al.; Department of Medicine, Division of Hematology/Oncology, Indiana University Medical Center, Indianapolis, IN. Vol. 18, No. 19 (October), 2000: pp 3346-3351.