Scientists have developed a test to identify patients who are at risk of suffering a relapse from testicular cancer. Assessing just 3 features of nonseminomatous germ cell tumor, a common kind of testicular cancer, it can identify those patients at greatest risk of relapse even when there is no evidence of tumor spread.

The researchers believe the test could be used in the clinic to make decisions about which patients should be given chemotherapy. Their findings were published in Clinical Cancer Research (2015; doi:10.1158/1078-0432.CCR-15-1186).

Scientists at The Institute of Cancer Research, London, analyzed 177 tumor samples from patients with stage I nonseminomatous tumors enrolled in clinical trials through the Medical Research Council (MRC) Clinical Trials Unit. The work was funded by the MRC with support from the National Cancer Research Institute Testis Cancer Clinical Studies Group.

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Scientists at The Institute of Cancer Research (ICR) found that 3 different features of the tumors were important indicators of risk for relapse: the levels of a molecule called CXCL12, the percentage of the tumor with an appearance of cancer stem cells, and whether blood vessels were present in the tumor.

They scored tumors based on these features, and found that combining scores could divide patients up into 3 risk groups based on how likely they were to suffer a relapse of the disease within 2 years. Relapse beyond this time is rare in patients with testicular cancer.

The researchers found that most patients were low-risk, with 94.3% relapse-free for 2 years; among those at moderate-risk, 65.9% were relapse-free; and only 30% at high-risk were relapse-free for 2 years.

The researchers were able to validate the test in an additional group of 80 patients at The Royal Marsden NHS Foundation Trust.

Testicular germ cell tumors are the most common solid malignant tumor in young Caucasian men. Patients with early-stage disease face a choice between monitoring with treatment if relapse does occur or upfront chemotherapy with its associated long-term side effects. Predicting which patients should receive chemotherapy up front is therefore important to minimize treatment in this largely curable disease.

“Our research has led to the development of a test that can detect patients that will benefit from treatment up front and spare those who are at lower risk from the side effects of chemotherapy,” said study leader Professor Janet Shipley, PhD, professor of cancer molecular pathology at The Institute of Cancer Research, London.

“Chemotherapy is extremely effective in treating testicular cancer, but it can have long-term consequences for a patient’s health and well-being. Patients deemed at low risk of relapse could simply be monitored and potentially could avoid chemotherapy. Approaches such as this to minimize chemotherapy are particularly important for cancers like testicular cancer, which affect young adults who could live with the side-effects for decades.”