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Repeat, High-Dose Chemo Can Cure Testicular Cancer

This approach works even if initial treatment fails, researchers say

WEDNESDAY, July 25, 2007 (HealthDay News) -- Intensifying the dose of anticancer drugs can cure a large majority of men with testicular cancer after first-line chemotherapy fails, Indiana University physicians report.

"This was a regimen established by our group over 10 years ago, and now we show that it is applicable to all testicular cancer patients," said study senior author Dr. Rafat Abonour, associate dean for clinical research at the university's school of medicine.

The new findings are published in the July 26 issue of the New England Journal of Medicine.

That report is "testimony to the dedication and leadership of Dr. Larry Einhorn," Abonour said. Einhorn is lead author on the study and holds several titles at Indiana, most notably the Lance Armstrong Professor of Medicine -- a position that was established after the Tour de France bicycling champ was cured of his testicular cancer at the center.

According to Abonour, Einhorn led the way in establishing the value of drugs such as cisplatin in the treatment of testicular cancer decades ago and has worked steadily at expanding their use and value.

From 7,000 to 8,000 cases of the cancer are reported in the United States each year. The overall cure rate is 90 percent for the first round of treatment, but there is a subset of more deadly metastatic cases where the cancer has spread to other parts of the body. About 30 percent of those patients suffer relapses and require further treatment.

The journal report describes the results of what it calls "salvage chemotherapy" in 184 such men. The researchers report that a course of treatment centering on high dosages of anticancer drugs led 116 of them to complete cancer remission over an average follow-up of four years. Even among a subset of 49 men for whom two or more previous rounds of treatment had failed, almost half (22 men) were found to be free of cancer four years later.

"The take-home message is that continuous effort to provide treatment is effective," Abonour said.

Cures are possible, because most testicular cancers are unusually sensitive to anticancer drugs, explained Dr. George Bosl, chairman of the department of medicine at Memorial Sloan-Kettering Cancer Center in New York City.

Most of those malignancies occur in "germ" cells, where sperm is produced. "The major point of this report is that if a young man with a germ cell tumor undergoes chemotherapy and if the disease remains afterward, very high doses of chemotherapy can cure a substantial fraction of those patients," Bosl said.

Unfortunately, the lessons learned from the treatment of testicular cancer may not extend to other malignancies, he said, "because germ cell tumors are different from other cancers, where curative chemotherapy in the first line of treatment is hard to come by." It is not yet clear why germ cells are so much more sensitive to anti-cancer drugs, Bosl said.

More information

You can learn more about testicular cancer from the Memorial Sloan-Kettering Cancer Center.

SOURCES: Rafat Abonour, M.D., associate dean for clinical research, Indiana Univerity, Indianapolis; George Bosl, M.D., chairman, department of medicine, Memorial Sloan-Kettering Cancer Center, New York City; July 26, 2007, New England Journal of Medicine
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