At first blush, putting more money into testicular cancer research may seem unnecessary. The long-term survival rate is high, and the number of new U.S. cases low, at 7,400 per year contrasted, for example, with 179,000 annual cases of prostate cancer.
However, the number of cases is increasing (see Stat Bite). And all cancer patients not just young men, for whom the disease is the most common type of cancer have benefitted from testicular cancer research. They stand to profit even more from ongoing work.
The drug cisplatin propelled the drop in testicular cancer mortality in the 1970s. Cisplatin then proved effective in ovarian and bladder cancers, and most recently it was shown to improve survival in cervical cancer patients. (See News, March 17, 1999.)
"Cisplatin probably would not exist in our therapeutic arsenal if not for its use in testicular cancer," said Larry Einhorn, M.D., president-elect of the American Society of Clinical Oncology. "It would have been discarded as an overly toxic and useless drug."
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And future gains are on their way. George Bosl, M.D., who researches testicular cancer as chairman of the Department of Medicine at Memorial Sloan-Kettering Cancer Center in New York, said the disease is a "stalking horse" for other cancers in four key areas:
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Molecular markers. Three blood tests for testicular cancer provide "without a doubt, the best markers for solid cancers," said Bosl. The discovery and refinement of these tests, which measure alpha-fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase levels, help predict survival and response to various treatments, allowing clinicians to triage patients into appropriate therapies. The markers are so robust that they have been added as a fourth category to the classical TNM staging system for testicular cancer.
Additionally, a marker chromosome called i(12p) is present in testicular cancer cells, including those that have metastasized. For example, if a mysterious tumor appears in the lungs but tests positive for i(12p), the clinician can infer it is a germ-cell tumor and can treat it accordingly. One study from Bosl and his colleagues found that nearly 25% of unknown chest tumors turned out to be germ-cell tumors using that marker.
Drug resistance. Most testicular tumors are exquisitely sensitive to chemotherapy but some aren't. Pinpointing why at a molecular genetic level may lead to better chemotherapy for other cancers. Bosl remarked that there is "a huge amount of effort" being funneled into this research.
Evidence-based medicine. "Almost every treatment we choose is based on one clinical trial or another," said Bosl. And testicular cancer patients treated with this best-practice medicine tend to fare better. Three large studies, including a recent European report (J Natl Cancer Inst, 1999; 91: 839-46), back up this claim by showing that testicular cancer patients treated at centers that is, institutions that see more cases of the disease tend to do better than patients treated at hospitals and clinics without much testicular cancer traffic. Why? Bosl said it appears clinicians at the larger places may tend to follow evidence-based guidelines more rigorously.
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