BEP for CS1 non-seminoma: revising recommendations
4th ESU Masterclass on Medical treatment of urological cancer
Wednesday, 1 July 2009- In clinical stage I testicular cancer, one cycle of polychemotherapy (BEP) is as efficient as the currently accepted norm of two cycles of the same treatment, was one of the key messages at the 4th ESU Masterclass on Medical treatment of urological cancer.
Presented by Prof. Axel Heidenreich of Universitätsklinikim Aachen (Germany), the lecture on systemic therapy of testicular cancer provided an essential update on the current treatment modalities for this pathology. The issues related to the management of stage I non-seminoma received most attention in the light of new findings of the German Testicular Cancer Study Group, recently published in Der Urologe.
The currently recommended two cycles of BEP, as an adjuvant alternative to first-line surveillance, significantly reduce the risk of relapse from 30% to 2%. Alternatively, patients might undergo nerve sparing retroperitoneal lymphadenectomy (RPLND), which leads to a somewhat higher risk of relapse – 10%
The study, conducted by a group of German urologists, evaluated the efficacy of one cycle of BEP vs RPLND, coming to a conclusion that this treatment modality could reduce the risk of recurrence rate to as low as 3%, being almost as efficient as the currently recommended two cycles.
“We know that all stage I non-seminoma patients are long-term survivors, so we were looking for ways to minimise all treatment-associated toxicity associated with chemotherapy - cardiac function, metabolic syndrome and testosterone deficiency," commented Prof. Heidenreich during his lecture at last week’s ESU Masterclass. “There has to be a balance between oncological efficacy and the side effects of the treatment.”
“Now we know that there is probably not much benefit associated with two cycles of BEP when we talk about high-risk non-seminoma patients,” he told Urosource. “That, in combination with the significantly reduced side effects, calls for a revision of today’s guidelines.”
Prof. Axel Heidenreich co-authored this German study, and he is also active in the EAU Guidelines activities.
“I believe that we need to revise our recommendation, and that should not take too long,” he added. “We will address this issue at the meeting of the European Germ Cell Cancer Consensus Group next year.”
In his lecture Heidenreich gave a comprehensive review of testicular cancer management, pointing out that in stage 1 (non-)seminoma risk-adapted approach is advised with active treatment delivered only to high-risk patients.
“RPLND is a ‘historical’ treatment for CS1 non-seminoma, and should not be used in the majority of cases,” he said in the conclusion of his lecture. “When it comes to patients who present with an advanced form of TC, they should be referred to tertiary centres that have extensive experience of managing this relatively rare type of pathology.”
4th ESU Masterclass on Medical treatment of urological cancer took place on 27-28 June in Barcelona, Spain, with more than 120 participants attending nine lectures divided into three modules. The masterclass aims to provide CME opportunities to urologists, medical oncologists and radiologists who practice in Europe.
Source: Hartmann et al. Results of the randomised phase III study of the German Testicular Cancer Study Group. Retroperitoneal lymphadenectomy versus one cycle BEP as adjuvant therapy for non-seminomatous testicular tumours in clinical stage I. Urologe A. 2009 May;48(5):523-8.
