Testicular Cancer: A Second Chance
New Treatment Strategy Uses Stem Cells Combined With High-Dose Chemo After Preferred Treatment Fails
July 25, 2007 - When the
preferred treatment fails to cure testicular cancer, a daring new
treatment strategy offers hope.
The strategy involves intensive
doses of chemotherapy. These doses would be lethal to blood cells, but
researchers rescue patients by giving them infusions of stem cells isolated
from the patients' own blood.
Can such a tricky business really
work? Yes, suggests a study by testicular cancer pioneer Lawrence Einhorn, MD,
Rafat Abonour, MD, and colleagues at Indiana University Cancer
The researchers tested the
treatment in 184 consecutive patients with metastatic testicular cancer that
continued to spread despite state-of-the-art, platinum-based, combination
Amazingly, 116 of these 184
patients had complete remission of their cancer without relapse for a median 48
"Over the years we have
mastered how to give these drugs -- two chemotherapy cycles with stem cell
support," Abonour tells WebMD. "We have been able to show we can cure
over 65% of these patients. Even among those not previously considered curable,
25% are cured with our approach."
The technique isn't without risk.
The drugs apparently killed three of the patients; two from liver failure and
the other from toxic effects on the lungs. Three others developed
leukemia; two died.
"The toxicity window is very
narrow," Manish Kohli, MD, a testicular cancer expert at the University of
Rochester School of Medicine, tells WebMD. "There were three drug-related
deaths in this study -- and that is in the hands of experts. But this provides
hope as an option for patients who respond poorly to first-line
Patients undergoing the treatment
take drugs that drive stem cells from the bone marrow to the blood. These cells
are harvested and stored. The patients then undergo high-dose chemotherapy
at five times the usual dose, followed by an infusion of stem cells to
replenish their blood cells. Three or four weeks later, doctors repeat the
"We give them the big-dose
chemotherapy, the big guns, to get rid of all the cancer cells. This also kills
off the bone marrow, so we replace it by infusing these healthy cells,"
Abonour says. "So the patients, instead of being without normal blood cells
for four to six weeks, it is only four to seven days. You can do it safely that
Testicular Cancer 'Eminently Curable'
Kohli, who was not involved in the study, notes that while some 7,200
American men get testicular cancer each year, only 380 die. The overall cure
rate is 90% -- and even when testicular cancer has spread, some 70% of patients
"This is an eminently curable cancer, so losing those 380 patients a
year pinches us," Kohli says. "It has been a dilemma how to treat these
patients. They are typically very young men in their late 30s or early 40s.
Much life is ahead of them, and we want them to live as long as