High-dose chemotherapy and a stem cell transplant cures testicular cancer

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 the treatment of this disease by Lawrence Einhorn, M.D., 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 for men, who typically are in their 20s when diagnosed with testicular cancer.

It is rare for the NEJM to carry a retrospective study from a single institution that is not a randomized study. This review looks at the outcome of 184 patients with metastatic testicular cancer. Dr. 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 is given to replenish the body's immune system through a process similar to a blood transfusion. Three to four weeks later the entire process is repeated.

"The message for patients is that through research, diligence and new technologies there is hope," said Dr. Einhorn, professor of medicine at the Indiana University Melvin and Bren Simon Cancer Center and the 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," said Rafat Abonour, M.D., 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.

For the patients each year who are treated with this therapy, there is renewed hope. "This is new medicine and it tells patients that cures are on the horizon," said Stephen D. Williams, M.D., director of the IU Simon Cancer Center and a co-author of the paper.

Other IU co-authors include Amy Chamness, B.A.; Mary J. Brames, R.N.; and Susan M. Perkins, Ph.D.