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Adjuvant Carboplatin Prevents Relapse in High-risk Stage I Seminoma: Presented at ESMO

By Adrian Burton

NICE, FRANCE -- October 21, 2002 -- Adjuvant carboplatin treatment after surgery and radiotherapy is effective at preventing relapse in high-risk seminoma patients, according to research presented at the 27^th Congress of the European Society for Medical Oncology.

"At the present time, stage I seminoma – a relatively infrequent carcinoma – is curable in a high percentage of cases," said Dr. Jorge Aparicio, an oncologist at the La Fe University Hospital, Valencia, Spain. "These patients are usually treated with radiotherapy after orchiectomy. But radiotherapy can cause gastrointestinal problems or even other cancers. What we are looking for is to cure people with less of these side effects. One possibility is to give nothing after surgery since about 80 percent of people actually require nothing else; another is to give adjuvant therapy with carboplatin, which is not very toxic and is already known to be as good as radiotherapy."

The Spanish team (Spanish Germ Cell Cancer Group) retrospectively reviewed the cases of 60 stage I seminoma patients who were at high risk of relapse and who had received an orchiectomy and two courses of adjuvant carboplatin (400 mg/m² with a 28-day interval). The median age of patients was 35 years (range, 21-67 years), tumour size was greater than 40 mm in 62 percent of patients before surgery, and pre-orchiectomy beta-human chorionic gonadotropin (BHCG) levels were raised in 22 percent of patients.

At a median follow-up time of 48 months, only two patients had relapsed – one with a large retroperitoneal lymph node and the other with BHCG levels consistently over 200 mU/mL; but both were cured on etoposide and cisplatin salvage therapy. Toxicities were mostly grade 1 and 2 and very manageable (neutropenia in 12 percent of patients and thrombocytopenia in 5 percent of courses). No grade 3 or 4 toxicities were seen at all. All of these patients are alive (except for one, who died in complete remission because of a traffic accident), disease free, and have no sequelae.

Interestingly, when these results were compared to survival data for patients who were deemed to have a low risk of relapse, and therefore who received only orchiectomy, these high-risk patients on adjuvant chemotherapy fared much better (20% of a cohort of surgery-only patients relapsed).

"This probably means that we still cannot select those who are likely to relapse well enough," explained Dr. Aparicio. "This is the first study looking at its effects in selected patients. Carboplatin is extremely well tolerated, can be administered to outpatients in half an hour, and it looks like a good adjuvant treatment. We are now carrying out a larger trial to confirm this and to identify those patients who need it."

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