What’s New in Testicular Cancer Research?

Important research into testicular cancer is being done in many university hospitals, medical centers, and other institutions around the world. Each year, scientists find out more about what causes the disease, how to prevent it, and how to improve treatment.

Genetics

In recent years, researchers have found that changes in certain genes, such as PLAP, NANOG, SOX2, and REX1, appear to be linked to testicular cancer. These findings could someday help identify men at higher risk, but they need to be studied more.

Scientists are also studying changes in the genes of testicular cancer cells to learn more about the causes of this disease. Their hope is that improved understanding will lead to better treatment. Certain gene mutations found in the testicular cancer cells have been linked to resistance to chemotherapy and predict poor outcomes. These findings may help personalize treatment. They could also help find new drugs to treat testicular cancer, drugs that can target these gene mutations. A better understanding of the genetic changes will also help doctors decide which patients need further treatment and which ones can be safely treated with surgery alone.

Treatment

Clinical trials have refined doctors’ approaches to treating these cancers. For example, studies have found factors that help predict which patients have a particularly good prognosis and may not need lymph node surgery or radiation therapy. Studies also have found unfavorable prognostic factors that suggest certain patients may benefit from more intense treatment.

New drugs and new drug combinations are being tested for patients with testicular cancer that comes back or doesn't respond to treatment. And high-dose chemotherapy followed by a stem cell transplant is being studied for men who have tumors with a poor prognosis.

Sentinel lymph node biopsy is used for other types of cancer to help limit the number of nodes that are removed, which can decrease the risk of long-term side effects. Researchers are looking at how this procedure might be used with testicular cancer.

Other studies are using robotic-assisted surgery to remove lymph nodes after chemotherapy. It appears to be a safe option instead of standard "open" surgery, but more research is needed to show this and to see if there are other benefits.

Long-term treatment side effects

A large amount of work is being done to try to better understand, limit, and prevent the long-term toxicities of treatment while maintaining the high cure rate. Chemo combinations are being refined to see if eliminating certain drugs, replacing them with others, or lowering doses can reduce side effects for some men without reducing the effectiveness of treatment.

Doctors also want to be able to predict whose cancer is more likely to come back later (recur) and then base treatment on this. This way they couldn't under- or over-treat anyone. For instance, one study reported good results by individualizing treatment in men with metastatic cancer based on the decline of tumor marker (AFP and HCG) levels after chemo, giving more intense treatment to those with a slower decline.