In a recent study, researchers attempted to determine how effective one cycle of chemotherapy is for testicular cancer compared to the standard two-cycle.
The standard treatment for testicular cancer is adjuvant chemotherapy. The usual combination of medication used in chemotherapy usually results in a less than 5% recurrence of cancer.
There is some research evidence that suggests that instead of two cycles of chemotherapy, one cycle may be just as effective. If so, then up to 50% of patients might be receiving unnecessary treatment.
In a recent study by Cullen and colleagues, researchers sought to determine if one cycle of chemotherapy was just as effective as – or better than – two cycles in individuals with high-risk stage one testicular cancer. They wanted to see if there was a less than 5% recurrence of cancer in a two-year time period in those receiving this chemotherapy for testicular cancer.
This non-randomized, multicenter study was conducted in the U.K. and included 236 patients. Over the study period of two years, there were four cases of recurrent testicular cancer. Of these four patients, one experienced mortality, while the other three experienced remission. The rate of recurrence of malignant cancer over the two years was about 1.3% and determined to be about 1.8% over four years. When considering the benign recurrence (i.e., non-malignant) in addition to the malignant recurrence, this rate would be 2.6% and 3.1% over two and four years respectively.
The researchers also completed additional sensitivity analyses to account for study uncertainties and determined that the recurrence rate for malignant cancer over two years would be about 1.5%, but with the addition of benign recurrence, this rate would be 2.4% over two years. They also found that the survival rate over the two years, without any relapse, was about 97%.
Over two years, the recurrence rate for malignant cancer was 1.3%. It was 1.8% over four years. The researchers found that this result was comparable to two-cycle chemotherapy and that their results were similar to other studies examining one cycle chemotherapy.
The researchers noted that there is still debate and controversy surrounding this topic. They note that 3% of patients still needed surgery when recurrence occurred – regardless of whether these were malignant or benign. Finally, as this is a single-arm study, it is not as effective as other study types in determining the effectiveness of an intervention.
Written by Olajumoke Marissa Ologundudu, B.Sc. (Hons)
Reference: Cullen et al. The 111 Study: A Single-arm, Phase 3 Trial Evaluating One Cycle of Bleomycin, Etoposide, and Cisplatin as Adjuvant Chemotherapy in High-risk, Stage 1 Nonseminomatous or Combined Germ Cell Tumours of the Testis. Eur Urol. 2019;0:1-8. doi: https://doi.org/10.1016/j.eururo.2019.11.022
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