- A new study found just one cycle of chemo may be enough to stop recurrence of some testicular cancers.
- This study is just one of many that are revisiting cancer treatments in order to identify over-treatment.
- Experts say there’s a fine balance between providing the right treatment and not overexposing patients to dangerous side effects.
Recent cancer research is focused on new treatments, but also re-evaluating existing ones to ensure patients aren’t over treated and still have the most effective outcomes possible.
Such is the case for men battling testicular cancer.
A recent report published in European Urology found they may need just one cycle of chemotherapy — not the standard two cycles — to prevent recurrence.
Testicular cancer often comes back elsewhere in the body within 2 years of initial diagnosis and after surgery.
According to the trial, just one cycle of chemotherapy could stop the recurrence and reduce some of the debilitating side effects as well. Treating cancer to prevent recurrence is known as adjuvant therapy.
New research aims to better understand existing treatments and potentially de-escalate or de-intensify them.
“One of the biggest dilemmas facing medicine and particularly cancer care globally is providing the most efficacy in decreasing the chances of recurrence, increasing survival while minimizing collateral damage from treatments both near and long term,” explained Dr. Henry M. Kuerer, a breast surgeon and researcher with the MD Anderson Cancer Network.
The testicular cancer study isn’t the only one looking at optimizing existing treatments.
More data presented last year reported that older, frail patients with advanced gastroesophageal cancer who got lower doses of chemotherapy didn’t have worse survival outcomes when compared to those who had more chemotherapy.
“We are able to de-escalate surgery going from the need from mastectomy in many to lumpectomy in some, and further decreasing the need for complete axillary lymph node removal particularly after chemotherapy treatments which eradicate disease,” Kuerer noted.
Another study examined breast cancer patients who need chemotherapy but may be able to avoid standard surgery thanks to the data provided from image-guided biopsy.
Cancer screening is also being re-evaluated, noted Dr. Art Rastinehad, a urology oncologist from New York.
More information on effective screening ensures patients don’t undergo needless procedures that can also have long-term effects.
“Prostate cancer screening is another area that is going through a drastic change in the paradigm given imaging is not playing a major and primary role in selecting men at risk for a biopsy,” he told Healthline.
“Prostate cancer was the last solid organ cancer that did not use imaging as a part of its diagnostic pathway until last year,” he added.
Rastinehad does believe patients lose faith in doctors when they hear that they, or other patients, were overtreated. This is why having more research on existing treatments is so vital.
Much of the discussion around cancer focuses on finding a cure, but reassessing treatments can do more than treat the cancer — it can improve a persons’ quality of life as well.
This is the case for many testicular cancer patients, who are often diagnosed at a young age. Too much chemotherapy can leave them with other long-term ailments such as hearing loss.
“We tend to be focused on whether we can cure a cancer or not, but for a disease like testicular cancer which affects young people, it is also crucial to ensure treatment does not leave patients with a lifetime of adverse effects,” Dr. Emma Hall, who heads up clinical trials and statistics at the ICR, said in a statement.
“There is an important balance to be struck in giving men enough chemotherapy to stop their testicular cancer from coming back, without giving them so much that they suffer unnecessary side effects,” Hall said.
Dr. David L. Topolsky, a hematologist and oncologist at Cancer Treatment Centers of America, told Healthline that patients and doctors first assess the goal of treatment before choosing a treatment. They determine if the patient is curable, or if the treatment is aimed at control. Then, they can discuss side effects and the likelihood of recurrence.
In general, doctors are always reassessing how to improve the patient outcome while decreasing potential toxicities.
“When a cancer has a very good response (high cure rates), such as the case in testicular cancer, then the major focus can be on limiting toxicity,” Topolsky told Healthline.
The testicular cancer study involved 250 men with early stage testicular cancer who had a high risk of cancer recurrence after surgery.
Participants were given one 3-week cycle of chemotherapy known as BEP — a combination of the drugs bleomycin, etoposide, and the platinum agent cisplatin.
The researchers evaluated the percentage of men whose testicular cancer returned within 2 years of being treated with one cycle of chemotherapy. Then, they compared these relapse rates with established data from previous studies in patients who were given two cycles.
Testicular cancer returned in 3 men — 1.3 percent of participants. The recurrence rate was basically the same as in men who had two cycles of BEP.
Of participants, 41 percent who had one cycle of chemotherapy experienced one or more serious side effects such as sepsis, vomiting, or increased risk of infection. Just 2.6 percent had long-term effects such as hearing impairments.
Nigel Brockton, PhD, director of research at the American Institute for Cancer Research, said studies that re-examine existing cancer treatments are fairly recent.
“When they first started to cure people with cancer, it was literally throw as much as they could at it. You basically took people to the brink,” he told Healthline. “There weren’t targeted agents, you had to hit everything really hard.”
When cancer treatments started being developed, there were only single agents. They added agents to improve medication efficacy, but those came with more side effects.
But now, the medical community is in the “era of deintensification,” he said. This is because many cancer survivors have been left with needless side effects from receiving too much medication or too many cycles of it.
Brockton knows because he’s a two-time cancer survivor who has a heart condition caused by chemotherapy that he received 25 years ago.
Thanks to new information about dosing, the high dose of chemotherapy he received at the time is no long recommended.
Doctors need to keep up with the latest literature and be able to evaluate the quality of these studies in order to best advise patients, Kuerer said.
“We need to be certain that we deliver the most effective care while minimizing the collateral damage associated with cancer treatments. This is an ongoing and very exciting area in cancer research around the world. Both the doctors and patients are demanding this,” Kuerer said.
Doctors consider a patient’s recurrence risk when they determine dosing and how many rounds of treatment will be required, Brockton explained. They look at affected tissue and genes expressed to see if a patient may need a lower dose, or if they can skip a treatment completely.
Physicians are also looking at treating specific types of cancer in different ways. For instance, most head and neck cancers are now caused by the HPV virus compared to smoking and drinking. This knowledge can help better tailor treatments, Brockton added.
“This is all part of this era we’re in at the moment,” Brockton said.
While researchers are still looking at new treatments, it’s important to better understand and customize existing ones.
“As long as we’re not curing people, there’s a need for a new agent. [But] as long as we’re overtreating people, there’s a need to find where the balance is. We don’t want to stop either,” Brockton said.
“Overtreating is something you only know in hindsight,” said Brockton, who’s glad he got the treatment he did at the time despite his heart ailment.
Had he not, he doesn’t know if he would’ve survived.