A diagnosis of testicular cancer was once almost akin to a death sentence. Over the past 50 years, that’s dramatically changed. The chemotherapy regimen developed by Larry Einhorn, MD, has lifted the cure rate to almost 95 percent.
Testis Cancer Research Update
Though that’s impressive, Einhorn and his colleagues at Indiana University School of Medicine are not satisfied. We remain intent on improving testis cancer outcomes. We also believe patients should not have to endure long-term side effects for the sake of the cure. We are exploring treatments that will enhance outcomes for men who see their cancer return, including options beyond traditional chemotherapy. We’re closing in on a biomarker that can help detect the faintest traces of the disease.
Each year, about 8,000 men are diagnosed with testicular cancer. Often, they make their way to IU Melvin and Bren Simon Comprehensive Cancer Center, one of the few places in the nation with the expertise and resources to fundamentally alter outcomes. Our research does more than help cure those who turn to us–it changes the standard of care for patients worldwide.
With your philanthropic support, we can continue to provide this level of expertise for years to come.
Survivorship
For most patients, a combination of cisplatin and two other chemotherapy drugs eradicates their disease. Unfortunately, these drugs also have lasting side effects and, for some survivors, can disrupt daily life.
Lois Travis, MD, ScD, oversees work aimed at reducing or eliminating those side effects. Travis is an internationally recognized expert in survivorship and leads the Platinum Study. This global consortium is working to predict who is susceptible to toxicities from cisplatin and protect patients from side effects. Their findings will impact nearly 6 million people treated with platinum-based drugs worldwide.
The group linked hearing loss in some patients to the total dose of cisplatin they received. Others have a genetic variant that makes them susceptible to neuropathy. This information is invaluable and can help oncologists determine which patients might be most at risk and alter treatments accordingly.
The insights uncovered through this research will allow survivors to enjoy all life offers—to forge ahead in their careers, watch their children grow, and continue to enjoy intimacy with their partners.
For her contributions to the field of survivorship, Travis has been honored by Harvard University’s T.H. Chan School of Public Health.
Relapsed Disease
Almost 80 percent of men treated with Einhorn’s chemotherapy regimen are cured after their first round of treatments. Unfortunately, some see their testicular cancer return.
At Indiana University, the standard protocol for patients with relapsed disease is high-dose chemotherapy and a stem-cell transplant. Studies over the past 20 years have shown that this approach will cure about 60 percent of these patients.
However, Einhorn and his protégé, Nabil Adra, MD, are looking for ways to boost that cure rate.
IU is conducting a clinical trial giving one group of patients the time-tested therapy followed by observation. Another group is receiving intensive high-dose chemotherapy followed by a chemotherapy drug in pill form for three months as a maintenance therapy. The goal is to understand if this maintenance therapy improves the cure rate compared to men who receive high-dose chemotherapy alone.
This research is being funded by philanthropic support from donors like you. In many other cancers, pharmaceutical companies are more likely to invest and support such trials. That is not the case for a rare disease like testicular cancer, making donor support crucial for researchers to explore ways to advance treatment.
Refractory Disease
Unfortunately, there are still patients who are not cured by standard or intensive high-dose chemotherapy. Their cancer continues to spread even in the face of intensive treatments.
Several years ago, IU researchers conducted genomic testing on these patients. The results showed that their cancers often overexpress a certain protein that drives tumor growth. IU researchers immediately began to search for a way to block it.
In Spring 2021, Adra launched a clinical trial for a drug he hopes will do just that. The initial plan was to enroll 25 patients, but given early results, the trial was expanded to enroll up to 50 patients from across the country who will take a single pill orally each day. While it is still early, researchers are optimistic.
Unlike chemotherapy, this drug is a targeted therapy. It spares patients from the draining physical toll that comes with a cisplatin-based protocol. Additionally, patients can stay on the drug, which was initially developed for kidney cancer, if needed.
Biomarkers
Time is cancer’s ally. The longer it goes undetected—and untreated—the more challenging it can be to eliminate. Even when treatment is successful, oncologists need a tool to easily monitor whether the disease is trying to return.
While there are blood tests available, they are only about 60 percent accurate–a number far too low to ensure confidence. However, researchers have identified new potential biomarkers that hold promise. When heavy amounts are circulating in a patient’s bloodstream, it is evidence that a tumor is present.
IU researchers are developing and optimizing blood tests for these biomarkers, a minimally invasive way for physicians to detect microscopic amounts of testicular cancer. So far, data indicates it is roughly 90 percent accurate.
Now, scientists are working to clarify how best to interpret the results of this new blood test. For example, a patient with localized disease often undergoes surgery or chemotherapy to prevent cancer from recurring.
A highly accurate diagnostic test would help us know whether additional procedures such as surgery or chemotherapy are truly required–or whether a patient should be followed with close observation alone.
Support the Future of Testis Cancer Research
Philanthropy maximizes IU Simon Comprehensive Cancer Center’s push to develop new therapies and answer questions that save lives.
For other ways to support testicular cancer research, contact Amanda Massey at 317-274-3205 or acmassey@iu.edu.
