MRC trial shows single dose of drug is as effective as two weeks' radiotherapy for testicular cancer
22 July 2005
The largest-ever randomised trial in testicular cancer, funded by the Medical Research Council (MRC), has shown that a single dose of a drug called carboplatin is as effective as two to three weeks of daily radiotherapy. The results of the nine-year trial are published in this week's edition of The Lancet. The lead scientists, from Barts and The London, Queen Mary's School of Medicine and Dentistry, University of Wales, Cardiff and the MRC Clinical Trials Unit, say carboplatin could become the preferred treatment for the most common type of testicular cancer. It could also greatly assist resource-poor countries where access to radiotherapy equipment is limited.
Nearly 2000 men in the UK are diagnosed with testicular cancer each year and the incidence has doubled in the last 30 years. Most men are diagnosed when the cancer is confined to the testis, known as stage I disease. The most common type of stage I testicular cancer is seminoma and the standard treatment for it is surgery to remove the cancerous testicle, followed by a course of radiotherapy. Radiotherapy is extremely effective in preventing recurrence of the cancer, but has known disadvantages. In the short term, there is a risk of temporary infertility and of developing gastric irritation. In the longer term, more serious problems can include damage to the cardiovascular system and a slightly increased risk of developing new primary cancers in other organs.
Earlier small-scale trials led by Tim Oliver, Professor of Medical Oncology at Barts and The London, Queen Mary's School of Medicine and Dentistry, had suggested that a single injection of an existing cancer drug called carboplatin may be an effective alternative treatment to radiotherapy.
This large-scale randomised trial was conducted by the MRC Clinical Trials Unit, in collaboration with Professor Oliver and radiotherapy specialist Professor Malcolm Mason, University of Wales, Cardiff. It directly compared a group of patients treated with radiotherapy and another group treated with carboplatin. Nearly 1500 men from 70 hospitals in 14 countries took part in the trial. The results showed that a single injection of carboplatin was as effective in preventing recurrence as two to three weeks of daily radiotherapy. In addition, in the three months after starting treatment, patients treated with carboplatin took less time off work and suffered substantially less lethargy than those having radiotherapy. Another preliminary finding was that patients receiving carboplatin were less likely to develop tumours in their remaining testicle.
The principal investigator, Professor Tim Oliver said, "This large trial establishes, after 20 years of research and uncertainty, that one dose of carboplatin in the short term is as safe as radiation and it's less toxic. It might also open the way to enabling lumpectomy surgery for stage I seminoma and using chemotherapy for testis conservation."
Sally Stenning, senior statistician at the MRC Clinical Trials Unit added, "We will need to follow patients for several more years before we can be certain that tumour recurrence has been prevented rather than just delayed, but these results are nevertheless extremely encouraging. They are particularly good news for those countries where radiotherapy equipment is scarce."
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