IU School of Medicine

Testicular cancer patients who do not respond to traditional therapy can be cured with high-dose chemotherapy and a stem cell transplant, according to an Indiana University School of Medicine report in the July 26 issue of the New England Journal of Medicine.

About 90 percent of testicular cancer patients respond to traditional therapy, which involves multiple courses of cisplatin, first used successfully in treatment of the disease by Lawrence Einhorn at Indiana University Cancer Center in the early 1980s. That course of therapy turned a disease from a mostly fatal cancer into one of the more curable forms of cancer in men, who typically are in their 20s when diagnosed with testicular cancer.

The review, co-authored by Einhorn and IU School of Medicine colleagues Stephen D. Williams, Amy Chamness, Mary J. Brames, and Susan M. Perkins, looks at the outcome of 184 patients with metastatic testicular cancer. Einhorn and colleagues demonstrated that the disease is potentially curable with a high dose chemotherapy and stem cell transplant using cells harvested from the patient before the initial chemotherapy infusion.

The patients received carboplatin chemotherapy at five times the dosage administered to men receiving initial therapy. A side effect of the high dosage is a reduction of blood cells, so a stem cell transplant was given to replenish the body's immune system through a process similar to a blood transfusion. Three to four weeks later the entire process was repeated.

"The message for patients is that through research, diligence, and new technologies, there is hope," says Einhorn, professor of medicine at the Indiana University Melvin and Bren Simon Cancer Center and lead author of the study. "The bar is steadily being raised and more patients are being saved."

"This review confirms that high-dose chemotherapy combined with a stem cell transplant can provide a cure for a group of patients with relapsed testicular cancer," says Rafat Abonour, associate professor of medicine in the division of hematology/oncology and associate dean for clinical research at the IU School of Medicine.

Although the number of relapsed testicular cancer patients is small, the IU Simon Cancer Center treats a majority of them. As a leader in this treatment, the researchers were able to collect the necessary data for the NEJM retrospective. It is rare for the NEJM to carry such a retrospective study from a single institution that is not a randomized study.

"This is new medicine and it tells patients that cures are on the horizon," says co-author Stephen Williams, director of the IU Simon Cancer Center.

For more, see: http://content.nejm.org/current.shtml and http://iucc.iu.edu/