The CancerWeb Report, What's New In Cancer: November, 1996
Testicular Cancer

• Review of 16 years of patient data from Germany - Testicular cancer is the commonest cancer in men aged less than 40. A study from the University of Munich in Germany reviewed the data from 266 patients with testicular cancer who were treated between 1979 and 1995 with chemotherapy that always included cisplatin. As reported in the October, 1996 issue of the British Journal of Cancer, 3-year overall and progression-free survivals were 77% and 71%, respectively. Identified risk factors for poor survival were liver, bone or brain metastases, elevated serum human chorionic gonadotrophic hormone (above 10,000 units per liter) or alpha-fetoprotein (above 1,000 ng/mL), a mass near the middle spine area (mediastinum) bigger than 5 cm, and 20 or more lung metastases. Those with none of these factors had 91% survival, whether or not chemotherapy included etoposide or vinblastine, compared with 61% for the remainder. When treatment included etoposide, survival was significantly improved for those having at least one risk factor. There were 14 patients who relapsed after a disease-free interval exceeding 2 years, and nine died more than 5 years after beginning treatment. There were 7 with second tumors, 5 being germ-cell and 2 of non germ-cell type, but no case of secondary leukemia was seen among the 119 patients who received etoposide. The greatest improvements in survival occurred over the period 1979-1983 and again between 1989 and 1993. Cumulative experience in managing poor-risk patients and use of regimens containing etoposide appeared to be responsible for improving survival. (Gerl, Br J Cancer 74:1280, 1996)

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• Long-term effects of chemotherapy for testicular cancer - Treatment of testicular cancers is one of the major bright spots in chemotherapy, with lasting remissions after 3 or 4 cycles of chemotherapy in 70-80% of patients. However, as with another successful area, childhood cancers, this success has come at a price that only becomes evident down the road among the long-term survivors. An article in the November, 1996 issue of the Journal of Clinical Oncology detailed the incidence of long-term problems among 90 patients treated with platinum-containing chemotherapy regimens, and followed-up for 19-159 months. The most common finding was increased gonadotropin levels in 68% of patients; the adrenal androgen DHEA was also elevated. One third of patients had cardiovascular risk factors, including elevated serum cholesterol, with or without obesity, and 15% had arterial hypertension. Changes in serum minerals and creatinine were seen in 20%, and there were similar frequencies of altered hearing and of Raynaud's phenomenon, intermittent episodes of paleness and pain in the extremities brought on by cold exposure. The major predictor for toxicity was the cumulative dose of cisplatin, and this was especially evident for neurologic symptoms which ranged from 95 to 80% of patients, according to dose. The authors stressed the need for further studies of such cancer survivors. (Bokemeyer, J Clin Oncol 14:2923, 1996)