Testicular cancer chemotherapy

Testicular cancer SCLC NSCLC ANLL KS HD NHL BMT preparative chemotherapy gastric cancer... 

Bleomycin (BLM) was first isolated as a copper complex from a culture of Streptomyces verticillus. Since then numerous analogs have been prepared by modifying the conditions of fermentation. Bleomycins (114, bleomycin A2) are used clinically in combination cancer chemotherapy for the treatment of head and neck cancer, certain lymphomas, and testicular cancer (555). 

After over half a century of chemotherapy research, cancer remains one of the most difficult life-threatening diseases to treat, a consequence of factors that include limitations of animal models, tiunour diversity, drug resistance and the side effects of therapy. Although there have been successes, most notably in treatment of testicular cancer [1], chemotherapy can currently still offer only a modest increase in survival time in the majority of advanced disease cases [2], The incidence of cancer is increasing due to ageing populations in most countries, and it has been estimated that in 20 years time there will be 20 million new cancer patients worldwide each year [3]. An optimistic view, however, is that in the coming decades advances in prevention, detection and treatment will see cancer becoming considered not as a fatal but as a chronic disease [3]. 

Perera R, Tang D, Reed E, et al. Multiple biologic markers in testicular cancer patients treated with platinum-based chemotherapy. Cancer Res 1992 52 3558-3565. 

Nord C, Fossa SD, Egeland T. Excessive annual BMI increase after chemotherapy among young survivors of testicular cancer. Br J Cancer 2003 88 36-41. 

Therapeutic modalities in cancer treatment may involve surgery, radiation, and/or chemotherapy. The objectives of cancer chemotherapy include (1) cure, (2) reduction in tumor size, and (3) prolongation of life. At the present time, approximately 50 percent of patients with cancer can be cured, with drug treatment estimated to contribute in 17 percent of cases. Cancer chemotherapy can be curative in testicular cancer, diffuse large cell lymphoma, Hodgkin s disease, choriocarcinoma, certain childhood tumors (acute lymphoblastic leukemia, Burkitt s lymphoma, Wilms tumor, and embryonal rhabdomyosarcoma). Certain cancers are more resistant to chemotherapy than others (e.g., lung and colon). 

Prior to the discovery of cisplatin, testicular cancer was known to be somewhat sensitive to chemotherapy the most active agent was dactinom-ycin, which produced responses in some 50% of patients, 10% of which were complete [35], Only 5% of patients were cured. As a result, patients were available to enter trials of new agents, and in the earliest Phase-I trials... 

The second important technological development was the widespread availability of computerized tomographic (CT) scanning. For testicular cancer this was critical to the initial quantitation of the extent of disease in a tumor that commonly involves the retroperitoneum and mediastinum, both difficult to assess by other means. Scanning was invaluable to define the presence of residual masses following chemotherapy surgical resection of these masses has been shown to maximize cure rates. 

Compared to other solid tumors, ovarian cancer is relatively responsive to chemotherapy, but unlike testicular cancer, cure is not common for patients with advanced disease. Prior to the incorporation of cisplatin or carboplatin into treatment regimens, chemotherapy for advanced-stage ovarian cancer consisted of combinations of alkylating agents and doxorubicin. Response rates from such regimens were of the order of 33-65%, and fewer than 10% of patients survived 5 years [51]. 

Cytotoxic chemotherapy is the cornerstone of therapy for metastatic testicular cancer. This type of cancer (known as a type of germ cell tumour as it is thought to be derived from cells in the germ cell lineage that are blocked in maturation) has been found to be extremely responsive to chemotherapeutic agents, in particular cisplatin and etoposide. There is no role for radiotherapy at this stage due to the advanced nature of the disease. 

Case study level Ma - Management of testicular cancer 178 Case study level Mb - Oral chemotherapy 181... 

Cancers originating from different organs of the body differ in their behaviour and in their response to treatments. Primary surgery and/or radiotherapy to a localised cancer offer the best chance of cure for patients. Drug treatments in the past were mainly restricted to patients with disseminated, metastatic ( advanced ) disease, where a systemic effect is required. Cytotoxic chemotherapy for advanced disease offers cure for only certain types of cancer, e.g. testicular cancers, Wilms tumour. Most often, chemotherapy may prolong life, although patients ultimately die of their disease. 

There is experimental evidence that several anticancer drugs can cause abnormalities of sperm chromosomes. Preliminary data have suggested that after platinum-containing chemotherapy for testicular cancer, penetration of oocytes can be severely impaired. Cytogenetic... 

In 86 patients treated with cisplatin-based chemotherapy for testicular cancer, cumulative exposure (over 400 mg/m ) and a previous history of noise exposure were significant susceptibility factors for irreversible ototoxicity high doses of vincristine (greater than 6 mg/m ) significantly increased the risk of reversible ototoxicity (287). 

Heier MS, Nilsen T, Graver V, Aass N, Fossa SD. Raynaud s phenomenon after combination chemotherapy of testicular cancer, measured by laser Doppler flowmetry. A pilot study. Br J Cancer 1991 63(4) 550-2. 

Nichols CR, Roth BJ, Williams SD, Gill I, Muggia EM, Stablein DM, Weiss RB, Einhorn LH. No evidence of acute cardiovascular complications of chemotherapy for testicular cancer an analysis of the Testicular Cancer Intergroup Study. J Clin Oncol 1992 10(5) 760-5. 

Doehn C, Buttner H, Fornara P, Jocham D. Fatal basilar artery thrombosis after chemotherapy for testicular cancer. Urol Int 2000 65(l) 43-5. 

Schilsky RL, Barlock A, Ozols RF. Persistent hypomagnesemia following cisplatin chemotherapy for testicular cancer. Cancer Treat Rep 1982 66(9) 1767-9. 

Nijman JM, Schraffordt Koops H, Oldhoff J, Kremer J, Sleijfer DT. Sexual function after surgery and combination chemotherapy in men with disseminated nonseminoma-tous testicular cancer. J Surg Oncol 1988 38(3) 182-6. 

EInhorn LH, Donohue J. CIs diammlne dichloroplatinlum, uniblastine and gleomycine combination chemotherapy in disseminated testicular cancer. Ann Intern Med. 1977.87 293. 

Platinum and its alloys are used in jewelry, dentistry, the chemical industry, and the electrical industry. Most automobile catalytic converters contain platinum. Certain platinum compounds that have the cis configuration and can combine with DNA are useful therapeutic agents for many cancers that do not respond readily to conventional chemotherapy (especially testicular, ovarian, bladder, prostate, and thyroid cancers). Testicular cancer, which was once always fatal, now responds to platinum-containing drugs. 

Such life-and-death questions pondered from afar suddenly cut a lot closer to the bone in 1979, when Peter was diagnosed with testicular cancer. There was nothing academic about listening to his divorced parents argue over which doctor they should trust with their son s life—the one who advocated a series of major, painful surgeries, or the other who would rely primarily on a difficult course of chemotherapy. Each treatment had its own risks, upside, and downside. There were no guarantees just terrifying discussions of mortality rates and survival rates. And it was Peter who had to make the call in the end. He was fifteen years old. 

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