Recent advances in the treatment of testicular cancer

Abstract

Testicular cancer is remarkable because it is curable by combination cytotoxic chemotherapy even when widely disseminated. Treatment is defined by widely accepted staging and prognostic factors. Three cycles of bleomycin, etoposide and cisplatin has been defined as the current optimum treatment in good prognosis metastatic disease, curing 90–95% of patients. Outcomes are less impressive for patients in intermediate and poor prognostic categories. A number of different approaches, including introduction of new agents and dose intensification, are being investigated to improve outcomes in these patients. Data developed over the last few years have identified increased risks of second malignancy and cardiovascular disease in long-term survivors. This has led to re-evaluation of strategies to manage Stage I patients. In particular, the use of radiotherapy in Stage I seminoma and the need for adjuvant therapy in Stage I nonseminoma are being re-examined. It is anticipated that advances in imaging and prognostic factors will facilitate this process.

Keywords::

• combination cytotoxic chemotherapy
• prognosis
• Stage I disease
• testicular cancer

Acknowledgements

This work was undertaken in The Royal Marsden National Health Service (NHS) Foundation Trust, who received a proportion of its funding from the NHS Executive. The views expressed in this publication are those of the authors and not necessarily those of the NHS Executive. This work was supported by the Institute of Cancer Research, the Bob Champion Cancer Trust and Cancer Research UK Section of Radiotherapy grant, number C46/A2131.

Notes

AUC: Area under the curve; BEP: Bleomycin, etoposide and cisplatin; CBOP: Carboplatin, bleomycin, vincristine and cisplatin; EP: Etoposide and cisplatin; PET: Positron emission tomography; TIP: Paclitaxel, ifosfamide and cisplatin.