1 BEP Cycle Found Sufficient for Preventive Chemotherapy After Testicular Cancer Surgery

Among men aged 15 - 35, testicular tumors are among the most common cancers. Following the discovery of platinum chemotherapy, they became among the most successfully treated cancers.

Testicular cancers develop in germ cells in more than %90 of cases. These special cells produce sperm. Men have two germ-cell tumor types: seminoma and nonseminoma . They look very different microscopically, and distinguishing them is essential for treatment strategy. Both types are examined at equal rates in testicular cancer.

Some contain seminoma and nonseminoma cells (mixed germ-cell tumors). Because these behave like nonseminomatous tumors, treatment is the same.

Treatment depends on disease stage and tumor subtype. For the high-risk stage-1 nonseminomatous or mixed (combined) germ-cell tumors discussed here, the main approach is orchiectomy surgery followed by 2 or 3 cycles of adjuvant chemotherapy.

The chemotherapy regimen is called the BEP protocol and contains bleomycin, etoposide and cisplatin. Although highly life-saving, BEP carries sometimes serious side effects. Researchers therefore tested whether, after orchiectomy for high-risk stage-1 nonseminomatous or mixed tumors, 2 BEP cycles could be replaced by 1.

Research presented at the American Society of Clinical Oncology’s 2017 Genitourinary Cancers Symposium found that with 1 BEP cycle in 236 patients, the 2-year recurrence rate was % 1.3. This 2-year rate resembled previously reported recurrence with 2 BEP cycles.

In conclusion, for high-risk stage-1 nonseminomatous or mixed testicular germ-cell tumors, adjuvant 1-cycle and 2-cycle BEP outcomes are similar. Accepting 1 cycle for a disease particularly affecting young people would reduce chemotherapy exposure.