While the majority of patients with testicular cancer are cured following standard therapy, some patients experience a recurrence of cancer following treatment. The survival rate of patients with recurrent testicular cancer who are treated following a cancer recurrence with standard therapy is approximately 20-25%. Recent clinical trials, however, have demonstrated an improved survival rate for patients with recurrent testicular cancer who are treated with high-dose chemotherapy followed by an autologous stem cell transplant.
Although relatively rare, cancer of the testicles is the most common cancer in men 15-35 years old. Testicles are located inside the scrotum (a loose sac of skin that lies directly under the penis). Sperm and male hormones are produced in the testicles. Cancer of the testicle occurs in the tissues of one or both testicles.
Chemotherapy targets and kills rapidly dividing cells, such as cancer cells. High-dose chemotherapy (HDC) kills more cancer cells than lower-dose conventional chemotherapy. Unfortunately, HDC also kills more normal cells, especially the blood producing stem cells in the bone marrow. The treatment strategy utilizing stem cell transplant is an attempt to restore the blood producing stem cells after HDC has reduced them to dangerously low levels.
Stem cells are immature cells produced in the bone marrow, the spongy material inside bones. Stem cells eventually become either red blood cells, which provide oxygen to tissues; white blood cells, which fight infection; or platelets, which aid in blood clotting. When these cells reach critically low levels from HDC, complications such as anemia, infection and bleeding can occur, which may result in death. Thus, it is imperative to restore stem cell levels as quickly as possible. In autologous stem cell transplantation, the patient’s own stem cells are collected before chemotherapy treatment, frozen, and infused back into the patients after treatment to “rescue” the bone marrow.
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Historically, early studies involving HDC and stem cell transplantation resulted in significant complications and patient deaths, limiting this treatment strategy to select patients. Recently, there has been marked improvement in supportive care, significantly reducing associated side effects with this treatment strategy. Ultimately, this has lead to the option of utilizing HDC as treatment in a larger percentage of patients as well as the ability to administer two sequential courses with limited side effects.
In a recent clinical trial, researchers evaluated the novel treatment strategy involving two sequential doses of HDC and autologous stem cell transplants in patients with recurrent testicular cancer. All of these patients received HDC and autologous stem cell transplantation as initial therapy following their recurrence. Three years following this treatment, almost 60% of these patients were cancer free. Not one patient died from complications related to high-dose treatment.
These results are consistent with previous clinical trials that suggest HDC and stem cell transplantation can significantly improve survival rates in patients with recurrent testicular cancer compared with standard therapy. Additionally, these results indicate that two sequential HDC treatments may augment the anti-cancer effects derived from HDC and improve disease free survival in patients. Patients with advanced testicular cancer may wish to speak with their physician about the risks and benefits of HDC and stem cell transplantation or about the participation in a clinical trial utilizing other promising treatments. Sources of information that can be discussed with a doctor include comprehensive, easy-to-use services provided by the National Cancer Institute (cancer.gov). (Journal of Clinical Oncology, Vol 18, No 19, pp 3346-3351, 2000).