International Germ Cell Cancer Collaborative Group update: positive news for seminoma germ cell cancer patients The story of testicular cancer has been one of success for several decades. The initial advance came with the introduction of chemotherapy. Further improvements have occurred, as with the rest of modern oncology. The difficulties of testicular cancer are now more readily identifiable through improved diagnostic means and supportive care, and in addition, treatment strategies can be continuously refined for different groups of patients.
To standardise disease classification and treatment strategies for such a rare disease it was realised early that national and international collaboration was necessary. A very recent, excellent example of such joint efforts is the International Germ-Cell Cancer Collaborative Group (IGCCCG) consortium who undertook an update on the characteristics of a patient that can be used to estimate the chance of recovery from a germ cell cancer or the chance of the disease recurring, i.e. prognostic factors.
Types of Testicular Cancer
The disease classification of the International GermCell Cancer Collaborative Group (IGCCCG) has been a major advance in the management of germ-cell tumours, but has, up until recently, relied on data of only 660 patients with seminoma treated between 1975 and 1990. The IGCCCG decided to re-evaluate the classification for seminoma in a database from a larger international consortium of 30 different contributing groups to the main database and a further 6 contributors for validation. This update included modern treatment data and investigated screening for additional patient characteristics that can predict the patient’s eventual response to an intervention or treatment. An update on survival rates was also provided.
The most common type of testicular cancer is a germ cell tumour (GCT). There are two main types of GCT: seminoma and nonseminomatous germ cell tumours (NSGCT).
Seminoma • S eminomas tend to grow and spread more slowly than NSGCT • I f seminoma spreads from the testicle, it is most often and best treated with chemotherapy and/or radiation
Nonseminoma • Very variable in appearance and prognosis • T here are four main types of NSGCT that can appear alone, but most often appear as a “mixed” NSGCT
The latest IGCCCG update provides a contemporary perspective on the outcomes for men diagnosed with seminoma. In the last few decades, we have reassuringly seen progressive improvement in the survival of men diagnosed with this condition, with an increasing majority now able to expect a cure following treatment. This is great news for our patients.
The update was undertaken for both seminoma and non-seminoma germ cell tumours, i.e. the two main types of testicular cancer. Compared with the results of the original IGCCCG group of patients, it was shown that there is now a substantially improved survival for patients with metastatic seminoma germ cell cancer. The results of the IGCCCG update analysis will now allow the testicular cancer multidisciplinary team to help counsel patients with seminoma more accurately in respect to the treatment outcome they can expect and also help shape future trials in seminoma. And also of importance, the original IGCCCG classification was shown to retain its relevance in metastatic seminoma, but with clearly improved outcomes.
Dr Ciara Conduit, Medical Oncologist & ANZUP Clinical Research Fellow A LITTLE BELOW THE BELT 41
