Testicular Cancer Survivorship: Research Strategies and Recommendations

• Published in: JNCI : Journal of the National Cancer Institute Vol. 102; no. 15; pp. 1114 - 1130
• Main Authors: Travis, Lois B., Beard, Clair, Allan, James M., Dahl, Alv A., Feldman, Darren R., Oldenburg, Jan, Daugaard, Gedske, Kelly, Jennifer L., Dolan, M. Eileen, Hannigan, Robyn, Constine, Louis S., Oeffinger, Kevin C., Okunieff, Paul, Armstrong, Greg, Wiljer, David, Miller, Robert C., Gietema, Jourik A., van Leeuwen, Flora E., Williams, Jacqueline P., Nichols, Craig R., Einhorn, Lawrence H., Fossa, Sophie D.
• Format: Journal Article
• Language: English
• Published: Cary, NC Oxford University Press 04.08.2010; Oxford Publishing Limited (England)
• Subjects: Adult; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - adverse effects; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Biological and medical sciences; Cardiovascular Diseases - chemically induced; Cardiovascular Diseases - genetics; Clinical Trials as Topic; Cognition - drug effects; Employment; Evidence-Based Medicine; Fatigue - chemically induced; Genetic Predisposition to Disease; Genome-Wide Association Study; Gynecology. Andrology. Obstetrics; Humans; Infertility, Male - chemically induced; Infertility, Male - genetics; Male; Male genital diseases; Medical diagnosis; Medical sciences; Medical treatment; Mens health; Models, Statistical; Neoplasm Recurrence, Local - prevention & control; Neoplasms, Second Primary - prevention & control; Paresthesia - chemically induced; Paresthesia - genetics; Platinum Compounds - administration & dosage; Platinum Compounds - adverse effects; Population Surveillance; Pulmonary Fibrosis - chemically induced; Pulmonary Fibrosis - genetics; Quality of Life; Renal Insufficiency - chemically induced; Renal Insufficiency - genetics; Risk Assessment; Risk factors; Survival Rate; Survivor; Survivors - statistics & numerical data; Testicular cancer; Testicular Neoplasms - drug therapy; Testicular Neoplasms - mortality; Testicular Neoplasms - psychology; Tumors; Young Adult; Human; Cancerology; Prognosis; Treatment; Complication; Malignant tumor; Male genital diseases; Survival; Testicular diseases; Testicle cancer; Recommendation; Cancer
• ISSN: 0027-8874; 1460-2105
• DOI: 10.1093/jnci/djq216

Testicular cancer represents the most curable solid tumor, with a 10-year survival rate of more than 95%. Given the young average age at diagnosis, it is estimated that effective treatment approaches, in particular, platinum-based chemotherapy, have resulted in an average gain of several decades of life. This success, however, is offset by the emergence of considerable long-term morbidity, including second malignant neoplasms, cardiovascular disease, neurotoxicity, nephrotoxicity, pulmonary toxicity, hypogonadism, decreased fertility, and psychosocial problems. Data on underlying genetic or molecular factors that might identify those patients at highest risk for late sequelae are sparse. Genome-wide association studies and other translational molecular approaches now provide opportunities to identify testicular cancer survivors at greatest risk for therapy-related complications to develop evidence-based long-term follow-up guidelines and interventional strategies. We review research priorities identified during an international workshop devoted to testicular cancer survivors. Recommendations include 1) institution of lifelong follow-up of testicular cancer survivors within a large cohort setting to ascertain risks of emerging toxicities and the evolution of known late sequelae, 2) development of comprehensive risk prediction models that include treatment factors and genetic modifiers of late sequelae, 3) elucidation of the effect(s) of decades-long exposure to low serum levels of platinum, 4) assessment of the overall burden of medical and psychosocial morbidity, and 5) the eventual formulation of evidence-based long-term follow-up guidelines and interventions. Just as testicular cancer once served as the paradigm of a curable malignancy, comprehensive follow-up studies of testicular cancer survivors can pioneer new methodologies in survivorship research for all adult-onset cancer.