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Systemic Therapies in the Management of Testicular Cancers

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Principles and Practice of Urooncology

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Abstract

Testicular cancer has become one of the most curable of solid tumors due to the prominent treatment advances beginning in the last 2–3 decades; it only accounts 0.1% of cancer-related deaths. The availability of effective therapies and the development of risk prediction models have increased the cure rate for testicular germ cell tumors (GCT) to approximately 95%. Approximately 70–80% of patients with seminomas and 30–60% of patients with nonseminomatous GCTs (NSGCT) present with stage I disease, and about 80% of patients with stage I seminomas and 70% of NSGCTs are cured with radical orchiectomy alone. The aim of this chapter is to summarize systemic therapies for testicular cancer especially GCTs.

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References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7–30.

    Article  PubMed  Google Scholar 

  2. Conkey DS, Howard GC, Grigor KM, et al. Testicular sex cord-stromal tumours: the Edinburgh experience 1988–2002, and a review of the literature. Clin Oncol (R Coll Radiol). 2005;17(5):322–7.

    Article  CAS  Google Scholar 

  3. Rajpert-De Meyts E, McGlynn KA, Okamoto K, et al. Testicular germ cell tumours. Lancet. 2016;387(10029):1762–74.

    Article  PubMed  Google Scholar 

  4. Hanna NH, Einhorn LH. Testicular cancer–discoveries and updates. N Engl J Med. 2014;371(21):2005–16.

    Article  PubMed  Google Scholar 

  5. Hanna N, Einhorn LH. Testicular cancer: a reflection on 50 years of discovery. J Clin Oncol. 2014;32(28):3085–92.

    Article  CAS  PubMed  Google Scholar 

  6. International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers. International germ cell cancer collaborative group. J Clin Oncol. 1997;15(2):594–603.

    Google Scholar 

  7. Jones G, Arthurs B, Kaya H, et al. Overall survival analysis of adjuvant radiation versus observation in stage I testicular seminoma: a surveillance, epidemiology, and end results (SEER) analysis. Am J Clin Oncol. 2013;36(5):500–4.

    Article  PubMed  Google Scholar 

  8. Warde P, Specht L, Horwich A, et al. Prognostic factors for relapse in stage I seminoma managed by surveillance: a pooled analysis. J Clin Oncol. 2002;20(22):4448–52.

    Article  PubMed  Google Scholar 

  9. Kollmannsberger C, Tandstad T, Bedard PL, et al. Patterns of relapse in patients with clinical stage I testicular cancer managed with active surveillance. J Clin Oncol. 2015;33(1):51–7.

    Article  PubMed  Google Scholar 

  10. Mortensen MS, Lauritsen J, Gundgaard MG, et al. A nationwide cohort study of stage I seminoma patients followed on a surveillance program. Eur Urol. 2014;66(6):1172–8.

    Article  PubMed  Google Scholar 

  11. Daugaard G, Gundgaard MG, Mortensen MS, et al. Surveillance for stage I nonseminoma testicular cancer: outcomes and long-term follow-up in a population-based cohort. J Clin Oncol. 2014;32(34):3817–23.

    Article  PubMed  Google Scholar 

  12. Oliver RT, Mason MD, Mead GM, et al. Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial. Lancet. 2005;366(9482):293–300.

    Article  CAS  Google Scholar 

  13. Oliver RT, Mead GM, Rustin GJ, et al. Randomized trial of carboplatin versus radiotherapy for stage I seminoma: mature results on relapse and contralateral testis cancer rates in MRC TE19/EORTC 30982 study (ISRCTN27163214). J Clin Oncol. 2011;29(8):957–62.

    Article  CAS  PubMed  Google Scholar 

  14. Albers P, Siener R, Krege S, et al. Randomized phase III trial comparing retroperitoneal lymph node dissection with one course of bleomycin and etoposide plus cisplatin chemotherapy in the adjuvant treatment of clinical stage I Nonseminomatous testicular germ cell tumors: AUO trial AH 01/94 by the German Testicular Cancer Study Group. J Clin Oncol. 2008;26(18):2966–72.

    Article  CAS  PubMed  Google Scholar 

  15. Tandstad T, Dahl O, Cohn-Cedermark G, et al. Risk-adapted treatment in clinical stage I nonseminomatous germ cell testicular cancer: the SWENOTECA management program. J Clin Oncol. 2009;27(13):2122–8.

    Article  PubMed  Google Scholar 

  16. Tandstad T, Stahl O, Hakansson U, et al. One course of adjuvant BEP in clinical stage I nonseminoma mature and expanded results from the SWENOTECA group. Ann Oncol. 2014;25(11):2167–72.

    Article  CAS  PubMed  Google Scholar 

  17. Heidenreich A, Pfister D. Retroperitoneal lymphadenectomy and resection for testicular cancer: an update on best practice. Ther Adv Urol. 2012;4(4):187–205.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Chovanec M, Hanna N, Cary KC, et al. Management of stage I testicular germ cell tumours. Nat Rev Urol. 2016;13(11):663–73.

    Article  CAS  PubMed  Google Scholar 

  19. Oldenburg J, Fossa SD, Nuver J, et al. Testicular seminoma and non-seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(Suppl 6):vi125–32.

    Article  PubMed  Google Scholar 

  20. Motzer RJ, Jonasch E, Agarwal N, et al. Testicular cancer, version 2.2015. J Natl Compr Canc Netw. 2015;13(6):772–99.

    Article  PubMed  Google Scholar 

  21. Beard CJ, Gupta S, Motzer RJ, et al. Follow-up management of patients with testicular cancer: a multidisciplinary consensus-based approach. J Natl Compr Canc Netw. 2015;13(6):811–22.

    Article  PubMed  Google Scholar 

  22. Classen J, Schmidberger H, Meisner C, et al. Radiotherapy for stages IIA/B testicular seminoma: final report of a prospective multicenter clinical trial. J Clin Oncol. 2003;21(6):1101–6.

    Article  PubMed  Google Scholar 

  23. Domont J, Massard C, Patrikidou A, et al. A risk-adapted strategy of radiotherapy or cisplatin-based chemotherapy in stage II seminoma. Urol Oncol. 2013;31(5):697–705.

    Article  CAS  PubMed  Google Scholar 

  24. Garcia-del-Muro X, Maroto P, Guma J, et al. Chemotherapy as an alternative to radiotherapy in the treatment of stage IIA and IIB testicular seminoma: a Spanish germ cell cancer group study. J Clin Oncol. 2008;26(33):5416–21.

    Article  CAS  PubMed  Google Scholar 

  25. De Santis M, Becherer A, Bokemeyer C, et al. 2-18fluoro-deoxy-D-glucose positron emission tomography is a reliable predictor for viable tumor in postchemotherapy seminoma: an update of the prospective multicentric SEMPET trial. J Clin Oncol. 2004;22(6):1034–9.

    Article  PubMed  Google Scholar 

  26. Culine S, Kerbrat P, Kramar A, et al. Refining the optimal chemotherapy regimen for good-risk metastatic nonseminomatous germ-cell tumors: a randomized trial of the Genito-Urinary Group of the French Federation of Cancer Centers (GETUG T93BP). Ann Oncol. 2007;18(5):917–24.

    Article  CAS  PubMed  Google Scholar 

  27. Ehrlich Y, Brames MJ, Beck SD, et al. Long-term follow-up of Cisplatin combination chemotherapy in patients with disseminated nonseminomatous germ cell tumors: is a postchemotherapy retroperitoneal lymph node dissection needed after complete remission? J Clin Oncol. 2010;28(4):531–6.

    Article  CAS  PubMed  Google Scholar 

  28. Ravi P, Gray KP, O’Donnell EK, et al. A meta-analysis of patient outcomes with subcentimeter disease after chemotherapy for metastatic non-seminomatous germ cell tumor. Ann Oncol. 2014;25(2):331–8.

    Article  CAS  PubMed  Google Scholar 

  29. Motzer RJ, Sheinfeld J, Mazumdar M, et al. Etoposide and cisplatin adjuvant therapy for patients with pathologic stage II germ cell tumors. J Clin Oncol. 1995;13(11):2700–4.

    Article  CAS  PubMed  Google Scholar 

  30. de Wit R, Roberts JT, Wilkinson PM, et al. Equivalence of three or four cycles of bleomycin, etoposide, and cisplatin chemotherapy and of a 3- or 5-day schedule in good-prognosis germ cell cancer: a randomized study of the European Organization for Research and Treatment of Cancer Genitourinary Tract Cancer Cooperative Group and the Medical Research Council. J Clin Oncol. 2001;19(6):1629–40.

    Article  PubMed  Google Scholar 

  31. Klepp O, Flodgren P, Maartman-Moe H, et al. Early clinical stages (CS1, CS1Mk+ and CS2A) of non-seminomatous testis cancer. Value of pre- and post-orchiectomy serum tumor marker information in prediction of retroperitoneal lymph node metastases. Swedish-Norwegian Testicular Cancer Project (SWENOTECA). Ann Oncol. 1990;1(4):281–8.

    Article  CAS  PubMed  Google Scholar 

  32. Bokemeyer C, Kohrmann O, Tischler J, et al. A randomized trial of cisplatin, etoposide and bleomycin (PEB) versus carboplatin, etoposide and bleomycin (CEB) for patients with ‘good-risk’ metastatic non-seminomatous germ cell tumors. Ann Oncol. 1996;7(10):1015–21.

    Article  CAS  PubMed  Google Scholar 

  33. Williams SD, Birch R, Einhorn LH, et al. Treatment of disseminated germ-cell tumors with cisplatin, bleomycin, and either vinblastine or etoposide. N Engl J Med. 1987;316(23):1435–40.

    Article  CAS  PubMed  Google Scholar 

  34. Massard C, Plantade A, Gross-Goupil M, et al. Poor prognosis nonseminomatous germ-cell tumours (NSGCTs): should chemotherapy doses be reduced at first cycle to prevent acute respiratory distress syndrome in patients with multiple lung metastases? Ann Oncol. 2010;21(8):1585–8.

    Article  CAS  PubMed  Google Scholar 

  35. Nichols CR, Catalano PJ, Crawford ED, et al. Randomized comparison of cisplatin and etoposide and either bleomycin or ifosfamide in treatment of advanced disseminated germ cell tumors: an Eastern Cooperative Oncology Group, Southwest Oncology Group, and Cancer and Leukemia Group B Study. J Clin Oncol. 1998;16(4):1287–93.

    Article  CAS  PubMed  Google Scholar 

  36. Hinton S, Catalano PJ, Einhorn LH, et al. Cisplatin, etoposide and either bleomycin or ifosfamide in the treatment of disseminated germ cell tumors: final analysis of an intergroup trial. Cancer. 2003;97(8):1869–75.

    Article  CAS  PubMed  Google Scholar 

  37. Motzer RJ, Nichols CJ, Margolin KA, et al. Phase III randomized trial of conventional-dose chemotherapy with or without high-dose chemotherapy and autologous hematopoietic stem-cell rescue as first-line treatment for patients with poor-prognosis metastatic germ cell tumors. J Clin Oncol. 2007;25(3):247–56.

    Article  CAS  PubMed  Google Scholar 

  38. Daugaard G, Skoneczna I, Aass N, et al. A randomized phase III study comparing standard dose BEP with sequential high-dose cisplatin, etoposide, and ifosfamide (VIP) plus stem-cell support in males with poor-prognosis germ-cell cancer. An intergroup study of EORTC, GTCSG, and Grupo Germinal (EORTC 30974). Ann Oncol. 2011;22(5):1054–61.

    Article  CAS  PubMed  Google Scholar 

  39. Fizazi K, Pagliaro L, Laplanche A, et al. Personalised chemotherapy based on tumour marker decline in poor prognosis germ-cell tumours (GETUG 13): a phase 3, multicentre, randomised trial. Lancet Oncol. 2014;15(13):1442–50.

    Article  CAS  PubMed  Google Scholar 

  40. International Prognostic Factors Study Group, Lorch A, Beyer J, et al. Prognostic factors in patients with metastatic germ cell tumors who experienced treatment failure with cisplatin-based first-line chemotherapy. J Clin Oncol. 2010;28(33):4906–11.

    Article  Google Scholar 

  41. Loehrer PJ Sr, Lauer R, Roth BJ, et al. Salvage therapy in recurrent germ cell cancer: ifosfamide and cisplatin plus either vinblastine or etoposide. Ann Intern Med. 1988;109(7):540–6.

    Article  PubMed  Google Scholar 

  42. Kondagunta GV, Bacik J, Donadio A, et al. Combination of paclitaxel, ifosfamide, and cisplatin is an effective second-line therapy for patients with relapsed testicular germ cell tumors. J Clin Oncol. 2005;23(27):6549–55.

    Article  CAS  PubMed  Google Scholar 

  43. Pico JL, Rosti G, Kramar A, et al. A randomised trial of high-dose chemotherapy in the salvage treatment of patients failing first-line platinum chemotherapy for advanced germ cell tumours. Ann Oncol. 2005;16(7):1152–9.

    Article  PubMed  Google Scholar 

  44. Lorch A, Bascoul-Mollevi C, Kramar A, et al. Conventional-dose versus high-dose chemotherapy as first salvage treatment in male patients with metastatic germ cell tumors: evidence from a large international database. J Clin Oncol. 2011;29(16):2178–84.

    Article  PubMed  Google Scholar 

  45. Lorch A, Neubauer A, Hackenthal M, et al. High-dose chemotherapy (HDCT) as second-salvage treatment in patients with multiple relapsed or refractory germ-cell tumors. Ann Oncol. 2010;21(4):820–5.

    Article  CAS  PubMed  Google Scholar 

  46. De Giorgi U, G. Rosti, M. Aieta, et al. Phase II study of oxaliplatin and gemcitabine salvage chemotherapy in patients with cisplatin-refractory nonseminomatous germ cell tumor. Eur Urol. 2006;50(5):1032–8; discussion 1038–9.

    Google Scholar 

  47. Pectasides D, Pectasides M, Farmakis D, et al. Gemcitabine and oxaliplatin (GEMOX) in patients with cisplatin-refractory germ cell tumors: a phase II study. Ann Oncol. 2004;15(3):493–7.

    Article  CAS  PubMed  Google Scholar 

  48. Einhorn LH, Brames MJ, Juliar B, et al. Phase II study of paclitaxel plus gemcitabine salvage chemotherapy for germ cell tumors after progression following high-dose chemotherapy with tandem transplant. J Clin Oncol. 2007;25(5):513–6.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Medical Oncology, Ankara Atatürk Education and Research Hospital, Ankara Yıldırım Beyazıt University, Ankara, Turkey

    Mehmet Ali Nahit Şendur M.D.

  2. Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey

    Sercan Aksoy M.D.

Authors
  1. Mehmet Ali Nahit Şendur M.D.
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  2. Sercan Aksoy M.D.
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Corresponding author

Correspondence to Mehmet Ali Nahit Şendur M.D. .

Editor information

Editors and Affiliations

  1. Chair and Professor, Department of Radiation Oncology, Hacettepe University, Ankara, Turkey

    Gokhan Ozyigit

  2. Chair and Professor, Department of Radiation Oncology, Koc University, Istanbul, Turkey

    Ugur Selek

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Şendur, M.A.N., Aksoy, S. (2017). Systemic Therapies in the Management of Testicular Cancers. In: Ozyigit, G., Selek, U. (eds) Principles and Practice of Urooncology. Springer, Cham. https://doi.org/10.1007/978-3-319-56114-1_8

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  • DOI: https://doi.org/10.1007/978-3-319-56114-1_8

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