Testicular cancer – response adapted treatment, prognostic markers and survivorship issues

Abstract: In the US and most European countries, testicular cancer is the most common malignancy in young men aged 20-40 years. Since the introduction of cisplatin-based treatment in the 1970s, more than 95% of the patients are cured. The increasing incidence of testicular cancer and high survival rates, has led to a growing number of testicular cancer survivors (TCSs). As they have a long life expectancy it’s important to minimize the treatment burden without compromising outcome in order to minimize the risk of late toxicity. In the first study the aim was to evaluate the SWENOTECA IV (Swedish-Norwegian Testicular Cancer Group) treatment strategy for patients with metastatic NSGCT with respect to outcome. The protocol was designed for early identification of patients, in whom the response to two standard chemotherapy courses was inadequate and to provide intensified treatment to these individuals. Tumor marker decline and, for patients with marker negative disease, radiological assessment were to be used for response evaluation. The conclusion was that with detailed treatment protocols and a dedicated collaborative group of specialists, treatment results comparable to those reported from large single institutions can be achieved at a national level. The survival of intermediate risk patients is remarkable and close to that of good risk patients. To investigate if testicular cancer survivors (TCSs) have a higher incidence of work loss compared with the general population, accounting for stage, treatment and relapse a cohort of TCSs was identified in the SWENOTECA register, and compared to matched population comparators. Prospectively recorded work loss data was obtained from national registers. Adjusted relative risks (RR) and 95% confidence intervals (CI) of sick leave and/or disability pension were calculated annually and overall with Poisson- and Cox regression, censoring at relapse. The mean number of annual work days lost was also estimated. The result indicated that extensively treated TCSs, but not those on surveillance or limited treatment, are at increased risk of work loss long-term, not explained by relapse. These patients may benefit from early rehabilitation initiatives. Expression of the RNA-binding motif protein 3 (RBM3) has been shown to correlate with favourable clinicopathological parameters and prognosis in several cancer diseases. The aim of the study was to examine the expression and prognostic ability of RBM3 in patients with testicular non-seminomatous germ cell tumors (NSGCT). Low RBM3 expression was a predictor of treatment failure in metastatic NSGCT, in relation to the prognostic factors included in the International Germ Cell Consensus Classification (IGCCC). These findings suggest that RBM3 may be a potential biomarker for treatment stratification in patients with metastatic non-seminomatous germ cell tumors, and therefore merit further validation.