Oct. 3, 2000 -- Lance Armstrong only brought a bronze medal home from the Sydney Olympics. The reason for the word "only" is because Armstrong, one of the world's premiere cyclists, is used to winning. Nowhere was this more evident than in the way he defeated his biggest challenge, an advanced case of testicular cancer, where winning was the only option.
Armstrong is not alone in his victory, though. Even though the treatment may be arduous, winning against testicular cancer is becoming more common, both among world-class athletes and the guy on the street.
"My own experience with testicular cancer parallels Lance's," says Chris Brewer, spokesperson for the Lance Armstrong Foundation and founder of the Testicular Cancer Resource Center. Brewer tells WebMD, "For both of us, the disease had already spread by the time it was detected. But we have both responded well to treatment and are disease free, and are praying we stay that way."
Even if the unthinkable happens and testicular cancer returns for Brewer or Armstrong, there is still a better than 50% cure rate for recurrent disease, according to a paper published in the current issue of the Journal of Clinical Oncology.
"For patients who come to me for the first time and require chemotherapy to treat their disease, I tell them that there will be certain problems associated with their therapy, but life will quickly go back to normal," Lawrence Einhorn, MD, tells WebMD. "But even for patients who relapse I can look them in the eye and say with a great deal of confidence even though you weren't cured the first time we still have over a 50% chance we'll cure you this time." Einhorn is Distinguished Professor in the department of medicine, Indiana University Medical Center in Indianapolis, and the study's senior author.
Einhorn and colleagues reviewed the records of more than 60 men treated for recurrent testicular cancer with therapy using high-dose chemotherapy and bone marrow transplantation. "This approach is possible in testicular cancer because we can escalate the dosage of the drugs we use by five or six times the dosage normally given and see something significant," Einhorn says. "This is not possible with drugs used for other solid tumors, such as breast cancer."
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."