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Carboplatin reduced risk for contralateral germ cell tumor

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CHICAGO — One course of carboplatin had a relapse-free rate similar to that of radiotherapy in stage I seminoma, according to data presented at the 2008 ASCO Annual Meeting.

“The 82% reduction of contralateral testis cancer at five years opens the possibility of testis conservation for these patients,” said Tim Oliver, MD, professor of medical oncology at Barts and the London School of Medicine and Dentistry of Queen Mary, University of London.

From 1996 to 2001, 1,447 patients were randomly assigned 3-to-5 to carboplatin or radiotherapy. The original data reported in 2004 indicated that one course of carboplatin was not inferior to radiotherapy for relapse-free rate.

After 6.5 years follow-up, the researchers found a significant difference in the rate of new germ cell cancers: two in patients who received carboplatin and 15 in patients who received radiotherapy (HR=0.22; 95% CI, 0.05-0.95). A high pretreatment follicle-stimulating hormone level was associated with an increased risk for a second germ cell cancer.

The five-year relapse-free rate was 92% for patients who received carboplatin and 96% for those who received radiotherapy. There was only one death from seminoma in the radiotherapy arm. – by Emily Shafer

For more information:

• Oliver RT, Mead GM, Fogarty PJ, et al. #1. Presented at: 2008 ASCO Annual Meeting; May 30-June 3, 2008; Chicago.

Radiation and surveillance are widely accepted standards for seminoma. From the results of this study, it seems like carboplatin is a possible, reasonable third option, but I would not say it is the standard of care. We do not have the data on late toxicity. Radiotherapy is an option, but becoming less preferred due to fear of secondary malignant neoplasms. Surveillance is an option, entailing the least treatment for greatest number of patients. Each choice has known and unknown risks. To achieve the best outcome, the patient needs to understand his options and risk profile. Risk-adapted surveillance-based management is probably the best approach.

– George Bosl, MD

Chairman of the Department of Medicine,
Memorial Sloan-Kettering Cancer Center