Medical treatment of advanced testicular cancer Journal Article
| Authors: | Feldman, D. R.; Bosl, G. J.; Sheinfeld, J.; Motzer, R. J. |
| Article Title: | Medical treatment of advanced testicular cancer |
| Abstract: | Context: The medical treatment of advanced testicular germ cell tumors has changed over the past 30 years, with long-term survival now achieved in the majority of patients. Clinicians need to be familiar with the available treatment regimens for testicular cancer and their associated toxic effects. Objective: To review the treatments used for advanced testicular germ cell tumors and their associated short-term and long-term complications. Evidence Acquisition: A search was performed of all English-language literature (1966 to October 2007) within the MEDLINE database using the terms neoplasms, germ cell, or embryonal or testicular neoplasms restricted to humans, drug therapy, complications, and mortality. The Cochrane Register of Controlled Trials Databases (through October 2007) was also searched using the terms testicular cancer or germ cell tumors. Bibliographies were reviewed to extract other relevant articles. One hundred eighty-six articles were selected based on pertinence to advanced testicular cancer treatment, associated complications, and late relapses with an emphasis on randomized controlled trials. Data Synthesis: The treatment of advanced testicular germ cell tumors with cisplatin combination chemotherapy is based on risk stratification (good, intermediate, or poor prognosis) according to pretreatment clinical features of prognostic value. Clinical trials have demonstrated that approximately 90% of patients classified as having a good prognosis achieve a durable complete remission to either 4 cycles of etoposide and cisplatin or 3 cycles of cisplatin, etoposide, and bleomycin. Complete responses are achieved less frequently for patients with intermediate- and poor-risk germ cell tumors, in whom 4 cycles of bleomycin, etoposide, and cisplatin remains the standard of care. Second- and third-line programs, including high-dose chemotherapy, also have curative potential. Chronic toxicities associated with therapy include cardiovascular disease, infertility, and secondary malignancies. Late relapses may also occur. Conclusions: Clinical trials have led to evidence-based treatment recommendations for advanced testicular cancer based on risk stratification. Clinicians should be familiar with the potential complications of these therapies. ©2008 American Medical Association. All rights reserved. |
| Keywords: | cancer survival; treatment response; leukemia; cancer surgery; clinical trial; constipation; neutropenia; review; salvage therapy; cisplatin; advanced cancer; cancer combination chemotherapy; diarrhea; drug dose comparison; drug withdrawal; multimodality cancer therapy; antineoplastic agents; skin manifestation; gemcitabine; paclitaxel; combined modality therapy; drug megadose; neurotoxicity; antineoplastic agent; lymph node excision; neoplasm; lymphadenectomy; carboplatin; metastasis; controlled clinical trial; lung toxicity; multiple cycle treatment; nephrotoxicity; etoposide; lung disease; neuropathy; randomized controlled trial; antineoplastic combined chemotherapy protocols; radiotherapy; cyclophosphamide; deep vein thrombosis; pathology; cancer mortality; ifosfamide; vinblastine; survivor; risk assessment; survivors; drug hypersensitivity; febrile neutropenia; hypomagnesemia; lung embolism; drug fatality; cancer regression; cardiovascular disease; heart infarction; stroke; thromboembolism; transient ischemic attack; testis tumor; testicular neoplasms; dactinomycin; bleomycin; corticosteroid derivative; cancer relapse; epirubicin; neoplasms, germ cell and embryonal; neoplasms, second primary; orchiectomy; second cancer; lifestyle modification; drug substitution; oxaliplatin; testis cancer; fertility; germ cell tumor; hemorrhagic cystitis; inappropriate vasopressin secretion; electrolyte disturbance; raynaud phenomenon; male infertility; ototoxicity; interstitial pneumonia; artery occlusion; angina pectoris; organizing pneumonia; bronchiolitis obliterans; retina artery occlusion |
| Journal Title: | JAMA - Journal of the American Medical Association |
| Volume: | 299 |
| Issue: | 6 |
| ISSN: | 0098-7484 |
| Publisher: | American Medical Association |
| Date Published: | 2008-02-13 |
| Start Page: | 672 |
| End Page: | 684 |
| Language: | English |
| DOI: | 10.1001/jama.299.6.672 |
| PUBMED: | 18270356 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 61" - "Export Date: 17 November 2011" - "CODEN: JAMAA" - "Source: Scopus" |
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