Management of patients with advanced seminoma
Prof Peter Albers - Düsseldorf University, Düsseldorf, Germany
The session today at ASCO is about metastatic seminoma, advanced seminoma patients. This is a special kind of testes cancer where two interesting abstracts are presented that try to tailor treatment and actually to reclassify those patients in order to sort out those that might not be treated as heavily as we used to in the past. So the first abstract is on the reclassification. There was a system twenty years ago published that distributed metastatic germ cell cancer patients into three prognostic groups and today we’re going to here have a presentation on seminoma patients. They’re reclassified – instead of 660 from twenty years ago, now they have 2,400 seminoma patients reclassified and the bottom line is that they actually find the same risk profile which was reported twenty years ago so no major change. But obviously if you would say the positive we didn’t do anything wrong in the last twenty years and we can now move on forward in more tailoring treatment to those guys. The unfavourable group is very small and most of the seminoma patients are good risk patients that have a 90% and more survival rate after proper treatment.
The second abstract is then actually following on this because if you now have 90% or more of patients surviving the disease then you should start thinking about reducing treatment. The French group performed a prospective trial where they used a radionuclide method, which is a PET scan, as a more or less biomarker for predicting what kind of treatment should follow after you have introduced this new imaging. So the classical treatment would be four cycles of etoposide or platinum or three cycles of platinum, etoposide and bleomycin and in this French trial they used the 4EP regimen as a standard. The new thing is after two cycles they stopped and performed an imaging procedure with FDG-PET and they saw that negative PET scan patients perhaps should stop treatment at two cycles and be followed only with one cycle of carboplatin. They compared it with the standard group that got four cycles if the signal was still positive and the recurrence rate actually was not much different. This is the first signal that perhaps in the future with larger trials we could stop treatment after two cycles of cisplatin.
The reason why it is so important to think about this treatment reduction is that we are treating very young patients. They are 20 years, 25 years old, and the Norwegian study group around Sophie Fosså has published data thirty years after cisplatinum treatment with a devastating development of secondary malignancies. So this is obviously due to treatment, cisplatinum or radiotherapy, and if you are able to reduce cisplatinum dosage then you may probably improve the situation to lower down the rate of secondary malignancies. So testes cancer patients are different from normal cancer patients because they are so young and they have a life expectancy which is comparable to a normal man without cancer. So it’s very, very interesting how much treatment do they really need in order to survive.