Testicular cancer can be prevented from coming back using half the amount of chemotherapy that is currently used, a new clinical trial has shown.
In many men who have had surgery for an aggressive form of testicular cancer, the disease can come back elsewhere in their bodies and need intensive treatment, often within two years after initial diagnosis.
The new trial showed that giving men one cycle of chemotherapy was as effective at preventing men’s testicular cancer from coming back as the two cycles used as standard. Crucially, lowering the overall exposure to chemotherapy reduced the debilitating side effects which can have a lifelong impact on patients’ health.
The 111 trial has already begun to change clinical practice, reducing the number of hospital admissions, and lowering the costs of treatment.
Most common cancer affecting young men
The 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.
The research was published in the journal European Urology and was funded by Cancer Research UK and the Queen Elizabeth Hospital Birmingham Charity.
Testicular cancer is the most common cancer affecting young men, with many patients being diagnosed in their twenties or thirties.
After surgery, patients are currently offered two cycles of chemotherapy to destroy any cancer cells that may have already spread, or a watch-and-wait approach – where they receive no treatment unless their cancer comes back, at which point they are given three cycles of chemo.
Survival rates are very high, but as men are diagnosed young, if they choose to have chemotherapy, they may have to live with long-term side effects for many decades.
One three-week cycle of chemotherapy
In the new study, patients were given one three-week cycle of a chemotherapy known as BEP – a combination of the drugs bleomycin, etoposide and the platinum agent cisplatin.
The researchers looked at the percentage of men whose testicular cancer returned within two 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.
The researchers found that only three men – 1.3 percent – saw their testicular cancer return after finishing treatment – a nearly identical rate to previous studies using two cycles of BEP chemotherapy.
In the new study, 41 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, or 2.6 percent – 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.
“Sparing young men from long-term side effects”
Professor Robert Huddart, Professor of Urological Cancer at the ICR, 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.
“Reducing the number of cycles and the dosage of chemotherapy for testicular cancer could save the NHS money, and free up valuable hospital time and resources.”
“Making treatment shorter, kinder and cheaper”
Professor Emma Hall, Deputy Director of the Clinical Trials and Statistics Unit at the ICR, said: “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.”
Martin Ledwick, Cancer Research UK’s head information nurse, said:
“Thanks to advances in treatments, survival for testicular cancer is very high, but the chemotherapy can cause unpleasant, sometimes lasting side effects. That’s why it’s such good news to see that we can cut down the amount of treatment we give.
“Providing men with a kinder treatment option linked to fewer side effects could make a huge difference to their quality of life. As more and more people survive cancer, it’s essential to carry out studies like this, which look at how to improve things for people living with and after the disease.”
Cullen et al. (2020) The 111 Study: A Single-arm, Phase 3 Trial Evaluating One Cycle of Bleomycin, Etoposide, and Cisplatin as Adjuvant Chemotherapy in High-risk, Stage 1 Nonseminomatous or Combined Germ Cell Tumours of the Testis. European Urology. DOI: https://doi.org/10.1016/j.eururo.2019.11.022
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