SIU Congress 2016: Shifting Sands: Testicular Cancer: High dose chemotherapy necessary for intermediate prognosis NSGCT? - Session Highlights

Buenos Aires, Argentina ( Juan Pablo Sade, Institute of Alexander Fleming, Argentina, discussed chemotherapy in management of NSGCT. High dose chemotherapy is confirmed via 5 randomized controlled trials confirming oncologic efficacy.

Two trials confirmed for intermediate risk group NSGCT. One trial no difference in overall survival between conventional chemotherapy (outdated by today’s standards) versus high dose chemotherapy. The other trial compared conventional chemotherapy with or without high dose chemotherapy arm with modern chemotherapeutic agents with comparable results. However, marker de line was suggestive of survival outcomes and in patients with modest marker decline suggests high dose might be beneficial in this subgroup. This years ASCO confirmed this finding regarding marker decline and benefit with high dose chemotherapy in this subgroup with poor marker decline. It should be noted this confirmation was in poor risk NSGCT patients and not intermediate risk, however, these data may be applicable to intermediate risk patients. Reclassification of these subgroups is also in question due to improved survival outcomes among intermediate and poor-risk patients given standardized chemotherapy regimens. Brain metastasis, lung metastasis, primary mediastinal, age 30+ years have been shown to be ominous predictors for survival which correlate with survival outcomes given number of these risk factors. BEP x4 is standard of care with slow tumor decline prognostic and predictive of patients who may benefit from high dose chemotherapy.

World Urological Oncology Federation Symposium at the SIU Congress 2016 - October 20 - 23, 2016 – Buenos Aires, Argentina

Written By: Stephen B. Williams, M.D., Assistant Professor in Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish Kamat, M.D. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.