New test help testicular cancers choose between monitoring and chemo15 Oct 2015
Scientists have developed a new test to identify patients who are at risk of suffering a relapse from testicular cancer.
Assessing just three features of a common kind of testicular cancer, called non-seminomatous germ cell tumor, they can identify those at most at risk of relapse even where there is no evidence of tumor spread. The researchers believe the test could be used in the clinic to make decisions about which patients should be given chemotherapy.
Testicular germ cell tumors are the most common solid malignant tumor in young Caucasian men. Patients diagnosed with early-stage disease face a choice between monitoring with treatment if relapse does occur or upfront chemotherapy with its associated long-term side-effects. Predicting who does or does not need chemotherapy up front is therefore important to minimize treatment in this largely curable disease.
The patients were divided into three different risk groups
Scientists at The Institute of Cancer Research, London, analyzed 177 tumor samples from patients with stage I non-seminomatous tumors enrolled in clinical trials through the Medical Research Council (MRC) Clinical Trials Unit.
They found that three different features of the tumors were important indicators of relapse risk:
- The levels of a molecule called CXCL12,
- The percentage of the tumor with an appearance of cancer stem cells and
- Whether or not blood vessels were present in the tumor.
They scored tumors based on these features, and found that combining scores could divide patients up into three different risk groups based on how likely patients were to suffer a relapse of the disease within two years. It is rare for a patient to relapse from testicular cancer beyond this time.
They found that the vast majority of patients were in the low-risk group, where 94.3% patients were relapse free for two years. In the moderate-risk group 65.9% patients were relapse free. Strikingly, only 30% patients were relapse free in the high-risk group.
The researchers were able to validate the test in an additional group of 80 patients at The Royal Marsden NHS Foundation Trust.
“The test must be tested in larger groups of men”
Study leader Professor Janet Shipley, Professor of Cancer Molecular Pathology at The Institute of Cancer Research, London, commented: "Our research has led to the development of a test that can detect patients that will benefit from treatment up front and spare those who are at lower risk from the side-effects of chemotherapy.
Professor Robert Huddart, Professor of Urological Cancer at The Institute of Cancer Research, London, and Consultant at The Royal Marsden NHS Foundation Trust, added that:”We now need to test this prognostic index in larger groups of men in the clinic."Source: Science Daily