Neoadjuvant Carboplatin Before Radiotherapy May Reduce Risk of Relapse and Long-Term Side Effects in Men With Testicular Cancer
A new study published in the Annals of Oncology reports that giving men with testicular cancer a single dose of chemotherapy before radiotherapy could improve the effectiveness of treatment and reduce the risk of long-term side effects.
As many as 96% of men with testicular cancer are predicted to survive at least 10 years from diagnosis, but more advanced forms of the disease need to be treated with combination chemotherapy, which can have serious long-term complications. Researchers at The Institute of Cancer Research, London (ICR) and The Royal Marsden NHS Foundation Trust have therefore been searching for new treatments that would reduce the risk of relapse after initial treatment and so spare as many men as possible from needing combination chemotherapy.
Pilot Study
The new pilot study tested a new treatment in men with stage IIA and IIB testicular seminoma. The researchers showed that neoadjuvant carboplatin could reduce relapse rates compared with radiotherapy alone, cutting the numbers of men who would need follow-up treatment. It also allowed radiation doses to be reduced.
Researchers gave 51 men with stage IIA and IIB testicular seminoma a single cycle of carboplatin—a low toxicity form of chemotherapy—followed 3 to 4 weeks later by radiotherapy. Most of the men were aged below 50, over a range of 18 to 73 years.
Adding carboplatin to patients’ treatment plans allowed doctors to give a lower dose of radiation over a smaller area of the body for most of the men in the study. Some 39 of the men in the study had their prescription of radiation reduced from the standard 35 Gy to 30 Gy, delivered to a smaller area of the abdomen.
After a median follow-up of 55 months (range 8–151 months), with 74% of patients having been followed for more than 2 years, there were no relapses of the cancer compared with a relapse risk of 5% to 11% after radiotherapy alone. The side effects from treatment were mild and only lasted a short time, with only five patients experiencing grade 3 toxicity and no patients experiencing grade 4 toxicity
Promising Results Warrant Further Investigation
Lead author Robert Huddart, PhD, Team Leader in the Division of Radiation and Imaging at the ICR and Consultant at The Royal Marsden, who led the study, commented, “The results of this study show great promise.… The aim of the study was to develop an effective nontoxic treatment with low risk of long-term treatment complications, and our findings suggest that a single cycle of carboplatin before radiotherapy may reduce the chances of cancer reappearing compared with radiotherapy alone. This will reduce the risk that these patients would need combination chemotherapy. Not only that, but by adding carboplatin to the therapy, the radiation dose and volume can be lowered.”
As this was a small, single-center study, the researchers are recommending the approach be evaluated more widely.
The study was funded by the ICR, the Bob Champion Cancer Trust, and Cancer Research UK, as well as through the NIHR Biomedical Research Centre at The Royal Marsden and the ICR.
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