Related Pages Search for Clinical Trials 1 NCI's PDQ® registry of cancer clinical trials. Testicular Cancer Home Page 2 NCI's gateway for information about testicular cancer. Highlights from ASCO 2008 3 (Posted: 06/18/2008, Updated: 06/24/2008) - A collection of links to material summarizing some of the important clinical trial results announced at the 2008 annual meeting of the American Society of Clinical Oncology (ASCO).

Keywords

Testicular cancer, seminoma, carboplatin, radiation therapy. (Definitions of many terms related to cancer can be found in the Cancer.gov Dictionary ⁴.)

Summary

One shot of carboplatin appeared to be as effective as radiation therapy as a post-surgical treatment for early seminoma, a kind of testicular cancer. Carboplatin also appeared safer than radiation therapy, reducing the risk of second cancers. Further follow-up is needed to show whether the benefits last.

Source

American Society of Clinical Oncology (ASCO) annual meeting, Chicago, June 2008 (see the meeting abstract ⁵).

Background

Seminoma accounts for about 30 percent of all testicular cancers. Typically, patients with early-stage seminoma undergo surgery to remove the affected testicle, then receive radiation therapy to prevent a recurrence. Radiation therapy cures the vast majority of early-stage seminomas but increases the risk of second cancers in organs such as the stomach, bladder, colon, rectum, and possibly the pancreas.

The Study

Between 1996 and 2001, researchers in the United Kingdom and Belgium enrolled 1,477 patients with stage I seminoma. The patients were randomly divided into two groups. One group received radiation therapy while the other received one injection of the chemotherapy drug carboplatin. The actual dose of carboplatin varied depending on the patient's kidney function.

The study’s research team was led by R. Timothy Oliver, M.D., of St. Bartholomews Hospital in London (see the protocol summary ⁶.) Results based on four years of patient follow-up were originally presented at the American Society of Clinical Oncology (ASCO) annual meeting in 2004. Updated results were presented at the 2008 ASCO meeting.

Results

The rates of cancer recurrence and second testicular cancers were comparable between the two groups. With a median follow-up of 6.5 years, 95 percent of the carboplatin group and 96 percent of the radiation therapy group were cancer free. In addition, two patients in the carboplatin group versus 15 in the radiation therapy group developed a tumor in the remaining testicle. This meant that men receiving carboplatin were 78 percent less likely to develop a new testicular tumor.

Limitations

In an editorial accompanying the publication of the study's initial results, radiation oncologists Padraig Warde, M.D., and Mary Gospodarowicz, M.D., of the University of Toronto in Ontario, Canada, wrote, "Whilst the results from this study confirm the benefit of carboplatin in stage I seminoma, we are not sure that adjuvant chemotherapy represents the best management strategy in this situation." Further relapses might occur in the carboplatin-treated group. In addition, the long-term side effects of carboplatin remain unknown.

Comment

“These are encouraging results,” said Wyndham Wilson, M.D., of the National Cancer Institute’s Center for Cancer Research about the study's initial findings. “They suggest that carboplatin may be safer than radiation” in terms of the risk of second cancers. With further follow-up, the difference between the trial’s two arms may become even greater, he added, “in that the risk of second cancer from radiation increases with time, out to 25 years and beyond.”

"Personal preference is becoming a more important factor in determining the best treatment for patients with testicular cancer," said Oliver at the 2008 ASCO meeting. "This study establishes surgery followed by carboplatin chemotherapy as a safe new alternative for patients who have early-stage seminoma and would prefer a treatment that lasts a shorter period of time" than the two to three weeks required by radiation therapy.

Glossary Terms

A drug that is used to treat advanced ovarian cancer that has never been treated or symptoms of ovarian cancer that has come back after treatment with other anticancer drugs. It is also used together with other drugs to treat advanced, metastatic, or recurrent non-small cell lung cancer and is being studied in the treatment of other types of cancer. Carboplatin is a form of the anticancer drug cisplatin and causes fewer side effects in patients. It attaches to DNA in cells and may kill cancer cells. It is a type of platinum compound. Also called Paraplatin.

A type of cancer of the testicles. Seminomas may spread to the lung, bone, liver, or brain.