A combination of chemotherapy drugs has shown promise in a group of patients with testicular cancer and other germ cell tumours who currently have a poor prognosis.
Chemotherapy has proven highly effective at treating testicular cancer and other germ cell cancers, but patients with a type of cancer called metastatic nonseminoma continue to have relatively poor survival.
A new phase II trial found that a chemotherapy regimen called CBOP/BEP, developed at The Institute of Cancer Research, London, and The Royal Marsden NHS Foundation Trust, has promise as a potential treatment for these cancers.
The standard course of chemotherapy for metastatic nonseminoma has remained bleomycin, etoposide and cisplatin (BEP) for many years, but while the regimen is successful for many patients, others continue to fare badly.
Nearly half of patients classed as having a poor prognosis with BEP treatment die within five years, highlighting the need for new and more effective options.
The phase II open-label randomised trial, run by the Medical Research Council and led by researchers at the ICR and The Royal Marsden, assessed outcomes in patients with poor-prognosis germ cell tumours.
The study, published in European Urology, compared the response rates to BEP with the intensive chemotherapy regimen called CBOP/BEP (carboplatin, bleomycin, vincristine, cisplatin/BEP).
A total of 89 patients were randomised from 16 UK centres, of which 46 were treated with conventional BEP, while 43 patients were treated with the new CBOP/BEP regimen.
They found that 74% of patients responded positively to CBOP/BEP, reducing tumour sizes and levels of biomarkers for the disease to normal levels, compared with 61% of patients treated with BEP.
But the trial did also find that CBOP/BEP was more toxic than BEP, suggesting that the risk–benefit ratio of the new chemotherapy might be debatable, and that more intensive treatments might need to be restricted to those most in need.
The researchers concluded that the findings were promising but that they required confirmation in larger-scale phase III trials.
The study was funded by Cancer Research UK with additional support from the Medical Research Council.
Study leader Dr Robert Huddart, Reader in the Division of Radiotherapy and Imaging at the ICR, and Honorary Consultant at The Royal Marsden, said: “Currently there is no accepted alternative to BEP. To improve on it it’s important to test new, more intensive ways to deliver a combination of drugs to treat testicular cancer. Although the new CBOP/BEP regimen caused more short-term toxicity, it met its preset activity goals and attained higher response rates than BEP. The results merit consideration for a phase III trial, but this will depend on international agreement.”