Commenting on both of these studies, Christian K. ­Kollmannsberger, MD, of the British Columbia Cancer Center, Vancouver, Canada, said: “These studies suggest a more personalized approach to testicular cancer. Clearly, we need to do better than traditional risk factors used to guide therapy for stage I and metastatic testicular cancer. So far, we have not seen any major study with regard to precision targets.”

“The study by Ko et al shows that if you survive for more than 2 years disease-free, it is likely you will remain alive in subsequent years. After 2 years, the rate of relapse is quite low, and for good- and intermediate-risk patients, after 18 months, there is not much relapse,” he said.

“This is an important piece of information. With data from this and other contemporary studies showing that the majority of relapses occur within the first 2 years, we may be able to design follow-up tests and lighten the [treatment] burden for our patients,” Dr. Kollmannsberger continued.

“The National Comprehensive Cancer Network Guidelines recommend significantly less imaging beyond 2 years. Other guidelines need to follow suit and adjust accordingly,” he added.

Dr. Ko’s study, as well as the study from Indiana University, looked at the same question and found that today’s patients do better than those in the original IGCCCG classification, he continued.

Reasons for improved outcomes included consequent utilization of postchemotherapy surgery, the widespread use of cisplatin/etoposide-based regimens, improved supportive care with less morbidity and mortality, and increasing use of guidelines and expert centers. “These improved outcomes need to be considered in designing clinical trials,” concluded Dr. Kollmannsberger. ■

Disclosure: Dr. Kollmannsberger is on the advisory board for Seattle Genetics.