Risk of Adverse Health Outcomes in Testicular Cancer Survivors After Cisplatin-Based Chemotherapy
In a study reported in the Journal of Clinical Oncology, Fung et al found that although adverse health outcomes were common among testicular cancer survivors, there did not appear to be differences in such outcomes according to chemotherapy regimens commonly used to treat favorable-risk disease. Historically, standard chemotherapy has consisted of three cycles of bleomycin, etoposide, and cisplatin (BEPX3) or four cycles of etoposide and cisplatin (EPX4) for favorable-risk disease and four cycles of BEP (BEPX4) for intermediate- or poor-risk disease.
Study Details
The study involved 952 survivors treated at sites in the United States and Canada. Patients had a median age at evaluation of 37 years and a median time since chemotherapy of 4.3 years. Chemotherapy consisted of BEPX3 in 38.2%, EPX4 in 30.9%, and BEPX4 in 17.9%. None, 1 to 2, 3 to 4, and ≥ 5 adverse health outcomes were reported by 20.4%, 42.0%, 25.1%, and 12.5% of survivors, respectively.
The median number of adverse health outcomes was 2 after EPX4 (range = 0–9) or BEPX3 (0–11) and 2 (0–10) after BEPX4. EPX4 was associated with a higher rate of peripheral neuropathy (29.2% vs 21.4%, P = .02), and BEPX3 was associated with a higher rate of Raynaud’s phenomenon (21.4% vs 11.6%, P < .01) and obesity (33.0% vs 25.5%, P = .04).
A higher cumulative bleomycin dose was associated with risk of ≥ 5 adverse health outcomes (odds ratio [OR] = 1.44/90,000 IU). Increasing age was associated with risk of increasing number of adverse health outcomes (ORs = 1.22 for 1–2, 1.50 for 3–4, and 1.87 for ≥ 5 per 5 years of age; P < .01), whereas vigorous physical activity was protective against the occurrence of multiple adverse health outcomes (ORs = 0.62 for 1–2, 0.51 for 3–4, and 0.41 for ≥ 5; P < .05).
Significant risk factors for 3 to 4 and for ≥ 5 adverse health outcomes included current smoking (ORs = 3.05 and 3.73) or former smoking (ORs = 1.61 and 1.76; P < .05). Self-reported health was excellent/very good in 59.9% of survivors but decreased in quality with an increasing number of adverse health outcomes (P < .001).
The investigators concluded: “Numbers of [adverse health outcomes] after EPX4 or BEPX3 appear similar, with median follow-up of 4.3 years. A healthy lifestyle was associated with reduced number of [adverse health outcomes].”
The study was supported by National Cancer Institute grants.
Lawrence H. Einhorn, MD, of the Indiana University Melvin and Bren Simon Cancer Center, is the corresponding author of the Journal of Clinical Oncology article.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
