Testicular Cancer Likely to Be Cured, Even When It Recurs
But the high-dose chemotherapy kills many of the parent cells in the bone marrow, which are necessary to make both red and white blood cells. This requires that the bone marrow be repopulated with parent cells using a technique called bone marrow transplantation.
"The technology surrounding bone marrow transplantation has greatly improved," says Einhorn. "We look at three things: death from treatment, which did not occur in this study; long-term toxicity such as ringing in the ears or tingling in the hands and feet, which also did not occur; and short-term toxicity. We can tell patients, who are for the most part young men, 'Look, you're looking at a very tough six to eight weeks with a high probability of cure.'"
Although Einhorn is convinced that this treatment regimen offers the highest possibility of cure for men with recurrent testicular cancer, Bruce Roth, MD, is a little more cautious. Roth tells WebMD, "I don't think we can say yet that this is the standard regimen that ought to be followed when someone has recurrent testicular cancer. Even though bone marrow transplantation is much better than it used to be and we don't usually kill anybody anymore, it is still extremely difficult for the patient and is quite expensive. The burden of proof is on us to prove that it's better than standard therapy." Roth is professor of medicine and urologic oncology and section chief of solid tumors at Vanderbilt University in Nashville.
Both Roth and Einhorn call themselves quite optimistic about the outlook for men with testicular cancer. "How many solid tumors are there where you can say to the patient on day one, you have a 90% chance of cure?" says Roth. "With any other solid tumor we'd be thrilled to give those odds. One thing I think is necessary, however, is for men with the disease to be treated by someone who regularly deals with this tumor, not someone who sees one or two cases a year. It's really necessary to understand the disease process."
Einhorn agrees, saying, "I really do think that when you're dealing with a rare, curable disease there are subtle nuances in its treatment. Large, central academic medical centers with a great deal of experience offer advantages related to having an entire infrastructure in place to support treatment. This is why we're always going to do better."