April 6, 2015 | by Sumanta Kumar Pal M.D.
The American Society of Clinical Oncology, a group that includes more than 40,000 cancer specialists around the country, recently issued a list of the five most profound cancer advances over the past five decades. Near the top of the list was the introduction of chemotherapy for testicular cancer. To many in the field, this comes as no surprise.
Prior to the advent of effective chemotherapy regimens, 90 percent of patients with advanced disease died. Now, the tables have turned entirely — more than 80 percent are survivors.
With April being Testicular Cancer Awareness Month, I think it’s entirely appropriate to celebrate these amazing statistics. After all, only a handful of cancers can be declared highly curable in 2015. As an oncologist, I can attest that treating testicular cancer can be highly rewarding. The disease tends to affect younger males, and a cure means they can return to the process of starting their careers and families.
However, it is important to draw a distinction between a disease that is highly curable and a disease that’s entirely curable — and testicular cancer is the former, not the latter.
A handful of patients still do not respond to conventional chemotherapy, and they face a treacherous course that can entail bone marrow transplant and high-dose chemotherapy regimens. Even with these aggressive measures, some patients will have continued cancer growth and die of their disease.
Etched in my mind are the dozen or so young men — 20- and 30-somethings — whom I have referred to hospice. One of those patients was a 26-year-old whom I will refer to as James. I remember James brimming with optimism when I conveyed to him the high cure rates typically associated with testicular cancer.
Imagine our disappointment when conventional chemotherapy did little to stop the growth of his cancer, which had migrated to his lungs and liver. This unfortunately turned out to be a recurring theme, with multiple lines of chemotherapy doing little to quell his disease. At the start of treatment, James had expressed aspirations to work as a writer, and had banked his sperm in hopes of one day starting a family. Unfortunately, none of this materialized.
What are the prospects for new treatments in these situations? To be frank, there is little clinical research that is ongoing. In comparison to more common cancers , for which multiple novel drugs are in clinical testing (e.g., prostate cancer or colon cancer), few studies focus on advanced testicular cancer.
I would argue that there is also little laboratory-based work ongoing in this domain. We have come a long way in understanding the molecular pathways that drive diseases such as lung cancer and melanoma in recent years, and these studies have driven drug development. In testicular cancer, we are a long way from understanding the genetic underpinnings of the disease.
So as we observe Testicular Cancer Awareness Month, I would call for a focus on those patients for whom a cure remains elusive. We need clinical trials for this population and an investment in science to better understand why these patients take on such a tragic course.
This month, as we celebrate our advances in treating testicular cancer, let’s kick-start efforts to make sure no patient gets left behind.
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