• Chemotherapy for Testicular Cancer

    Chemotherapy uses drugs to kill testicular cancer cells. The drugs enter the bloodstream and travel through the body to the cancer cells. Chemotherapy is generally used after surgery, if testicular cancer has spread beyond the primary site, or to relieve symptoms of metastatic cancer. For nonseminomas, it may be used in combination with radiation therapy (called chemoradiation).

    Chemotherapy Drugs and Delivery

    There are a variety of chemotherapy drugs. A combination of drugs is generally more effective. The choice and combination of drugs will be based on your particular cancer and reaction to drugs. Chemotherapy drugs for testicular cancer may include:
    • Cisplatin
    • Bleomycin
    • Etoposide
    • Paclitaxel
    • Vinblastine
    • Ifosfamide
    Chemotherapy is most often given through an IV, but some forms can be given by mouth. It is delivered in cycles over a set period of time. A medical oncologist will determine how many cycles of chemotherapy are needed and what combination of drugs will work best.

    High-Dose Chemotherapy

    Even with chemotherapy, testicular cancer can come back. If this is the case, a peripheral stem cell transplant may be an option.
    A peripheral stem cell transplant uses healthy stem cells (immature, unformed cells) from the circulating blood in your body or a donor to restore normal blood cell function. The cells travel to bone marrow sites throughout the body and slowly repopulate numbers of red or white blood cells, or platelets. If the transplant is successful, the newly injected cells should be free of cancer and capable of producing healthy cells.
    Healthy stem cells are harvested from the patient's own body. They are extracted from circulating blood. Circulating blood removed from the body is spun in a machine to separate the components in a process called apheresis. The blood is then circulated back into the body. The stem cells are frozen until all malignant testicular cancer cells are eliminated by high-dose chemotherapy. Lastly, the healthy stem cells are returned to the body to repopulate the blood cell count.

    Side Effects and Management

    Though the drugs are targeted to cancer cells, they can affect healthy cells as well. The death of cancer cells and impact on healthy cells can cause a range of side effects. A medical oncologist will work to find the best drug combination and dosage to have the most impact on the cancer cells and minimal side effects on healthy tissue. Side effects or complications from chemotherapy may include:
    • Nausea and vomiting
    • Diarrhea
    • Fatigue due to anemia
    • Low blood cell counts (white cells or platelets) that can lead to infection or bleeding
    • Numbness, pain, or burning sensation in the the hands and feet—peripheral neuropathy
    • Kidney damage
    • Shortness of breath (bleomycin)
    • Bleeding from the bladder (ifosfamide)
    A variety of treatments are available to help manage side effects including medication, lifestyle changes, and alternative treatments. In some cases, the chemotherapy regimen may be adjusted to reduce severe side effects. The earlier the side effects are addressed, the more likely they will be controlled with a minimum of discomfort.

    References

    Chemotherapy for testicular cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/testicular-cancer/treating/chemotherapy.html. Updated February 12, 2016. Accessed September 21, 2017.

    Drugs approved for testicular cancer. National Cancer Institute website. Available at: https://www.cancer.gov/about-cancer/treatment/drugs/testicular. Updated August 18, 2016. Accessed September 21, 2017.

    High-dose chemotherapy and stem cell tranplant for testicular cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/testicular-cancer/treating/high-dose-chemo-stem-cell.html. Updated February 12, 2016. Accessed September 21, 2017.

    Management of nonseminoma testicular cancer. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T908522/Management-of-nonseminoma-testicular-cancer. Updated May 31, 2017. Accessed September 21, 2017.

    Management of seminoma. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T908524/Management-of-seminoma. Updated May 31, 2017. Accessed September 21, 2017.

    8/11/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T908524/Management-of-seminoma: Oliver RT, Mead GM, Rustin GJ, et al. Randomized trial of carboplatin versus radiotherapy for stage I seminoma: mature results on relapse and contralateral testis cancer rates in MRC TE19/EORTC 30982 study (ISRCTN27163214. J Clin Oncol. 2011;29(8):957-962.

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