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One Cycle of Bleomycin/Etoposide/Cisplatin May Be as Effective as Two for Patients With Testicular Cancer


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Testicular cancer recurrence may be prevented by giving men one cycle of chemotherapy instead of the two cycles used as standard. Lowering the overall exposure to chemotherapy also reduced side effects. These findings were published by Cullen et al in European Urology.

Testicular cancer is the most common cancer affecting young men, with many patients being diagnosed in their 20s or 30s. After surgery, patients are currently offered two cycles of chemotherapy or a watch-and-wait approach—if their disease recurs, they are often given three cycles of chemotherapy. Survival rates are high, but as men are diagnosed young, if they experience adverse effects of chemotherapy, they may have to live with long-term side effects for many decades.

111 Trial

The 111 trial, led by The Institute of Cancer Research, London, and University Hospitals Birmingham NHS Foundation Trust, involved nearly 250 men with early-stage testicular cancer at high risk of their cancer returning after surgery. Patients were given one 3-week cycle of bleomycin, etoposide, and cisplatin.

The researchers looked at the percentage of men whose testicular cancer returned within 2 years of being treated with one cycle of chemotherapy and compared these relapse rates with established data from previous studies in patients who were given two cycles.

“Men with testicular cancer who are at high risk of recurrence have generally been treated with two cycles of chemotherapy—but our new study found that one cycle was enough to stop their tumor from coming back."
— Robert Huddart, MB, BS, MRCP, FRCR, PhD

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Results

The researchers found that only three men—1.3%—saw their testicular cancer return after finishing treatment, a nearly identical rate to previous studies that used two cycles of bleomycin/etoposide/cisplatin.

Forty-one percent of men receiving one cycle of chemotherapy experienced one or more serious side effects while receiving treatment, such as an increased risk of infection, sepsis, or vomiting. But only a small number—six patients, 2.6%—experienced long-term side effects such as damage to their hearing.

It is well established that lower chemotherapy doses are related to reduced rates of side effects, and the researchers are confident that the rates found in this study are substantially lower than those currently seen in the clinic.

Study author Robert Huddart, MB, BS, MRCP, FRCR, PhD, Professor of Urological Cancer at The Institute of Cancer Research, London, and Consultant in Urological Oncology at The Royal Marsden NHS Foundation Trust, said, “Men with testicular cancer who are at high risk of recurrence have generally been treated with two cycles of chemotherapy—but our new study found that one cycle was enough to stop their tumor from coming back. Reducing the overall dose of chemotherapy could spare young men who have their whole lives ahead of them from long-term side effects, and also means they will need fewer hospital visits for their treatment. This new trial is already changing clinical practice on a global scale, and is set to improve patients’ quality of life as well as reducing the cost of testicular cancer treatment.”

"Our study has found strong evidence to suggest that testicular cancer chemotherapy can be safely reduced from two cycles to just one—making ... treatment shorter, kinder, and cheaper."
— Emma Hall, PhD

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Study author Emma Hall, PhD, Deputy Director of the Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, added, “We tend to be focused on whether we can cure a cancer or not, but for a disease like testicular cancer, which affects young people, it is also crucial to ensure treatment does not leave patients with a lifetime of adverse effects. There is an important balance to be struck in giving men enough chemotherapy to stop their testicular cancer from coming back, without giving them so much that they suffer unnecessary side effects. Our study has found strong evidence to suggest that testicular cancer chemotherapy can be safely reduced from two cycles to just one—making their treatment shorter, kinder, and cheaper."

Disclosure: This study was funded by Cancer Research UK and the Queen Elizabeth Hospital Birmingham Charity. For full disclosures of the study authors, visit europeanurology.com.

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®.
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