Novel Therapies for Advanced Urologic Cancers

Axel Heidenreich

Disclosures

Curr Opin Urol. 2020;30(4):594-601. 

In This Article

Testis Cancer

There are two clinical studies that might have an important impact on daily routine in the management of patients with testicular germ cell tumours (TGCTs). Fischer et al.[25] evaluated the outcome of 51 clinical stage I nonseminoma patients who progressed after adjuvant chemotherapy with one cycle PEB. It was shown that the median time to progression after chemotherapy was 13 (2–25) months so that close follow-up is even mandatory in stage I patients treated by active therapy and not by active surveillance. Treatment of relapse was chemotherapy, surgery or a combination of both. After a median follow-up of 96 months, the 5-year PFS and OS were only 67 and 81%, respectively. The oncologic outcome seems to be worse as compared to those patients with de-novo metastatic TGCT. There are various strategies evolving from this small retrospective study: adjuvant chemotherapy triggers the development of chemoresistant disease in a few patients, AS followed by chemotherapy at time of de-novo metastatic disease might be the preferred options, intensification of chemotherapy in high risk stage I nonseminomas and nerve-sparing retroperitoneal lymph node dissection might be a therapeutic option considering the low morbidity and the high oncological efficacy.

In the context of intensification of systemic chemotherapy, Cullen et al.[26] have assessed the oncological efficacy of one-cycle 'high dose' PEB in 246 clinical stage I high-risk nonseminomas as defined by the presence of vascular invasion. Bleomycin was given at a dose of 30 000 IU on days 1, 8 and 15, whereas etposide and cisplatin were given at a dose of 165 and 50 mg/m2 on days 1 and 2. The primary endpoint was the 2-year rate of malignant recurrence defined by the presence of nonteratomatous elements or marker increase that should be less than 5%. After a median follow-up of 49 months, the 2-year malignant relapse rate was 1.3% and another three patients experienced nonmalignant recurrence with localized teratoma. Treatment-related toxicity of high grade was observed in 6.8% of patients who experienced grade 3–4 neutropenia.

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