Dose-intense or high-dose chemotherapy should be considered for multisite late relapsed (LR) nonresectable testicular tumours wherever feasible, say the authors of a new study published in European Urology Focus.
The retrospective analysis included all patients treated for advanced testicular cancer within the Anglian Germ Cell Cancer Network between 1995 and 2016. There were 53 cases of LR (>2 years) following initial treatment for metastatic disease with platinum-based chemotherapy.
Across the cohort, progression free survival (PFS) at 36 months was 41% and overall survival (OS) was 61%. Multiple factors were correlated with PFS.
The use of dose-intense or high-dose chemotherapy was associated with better PFS compared to conventional-dose chemotherapy (48 vs 9.8 months; P=0.0036). Resection of residual disease post-relapse chemotherapy was associated with better PFS (hazard ratio [HR] 3.46; P=0.0076).
There was a nonsignificant trend towards worse PFS in very late (>7 yr) relapses.
Although previous studies described LR testicular cancer as chemotherapy-resistant, most patients who achieved a cure did so after combination dose-intense chemotherapy and surgery.
This study provides new insight into prognostic factors in LR testicular cancer. It confirms that surgery is critical to optimal outcomes, and suggests that dose-intense or high-dose chemotherapy in multisite nonresectable disease should be considered wherever feasible.
