(UroToday.com) The 2024 American Society of Clinical Oncology Genitourinary (ASCO GU) cancers symposium held in San Francisco, CA between January 25th and 27th was host to a renal cell, adrenal, penile, urethral, and testicular cancers poster session. Dr. Jonathan Shamash presented the results of a UK-based large center analysis of survivorship issues beyond two years following treatment for testicular germ cell tumors.
Germ cell tumors are rare but highly curable malignancies, even at advanced stages. Given these excellent survival outcomes, combined with the young age at diagnosis, (often in the 20-to-30-year age group), this results in a large cohort of long-term testicular cancer survivors, with survivorship aspects and risk of cardiovascular/secondary malignancy risks taking on increased importance.
Current surveillance and follow-up programs are geared towards detecting recurrence with imaging and tumor markers at pre-determined intervals, especially in the first two years post-treatment. However, survivorship issues are wide ranging and becoming more important beyond the first two years of treatment. These survivorship issues are not widely discussed in the literature and are underreported in the clinical setting.
Barts Health NHS Trust is one of the largest healthcare Trusts in the United Kingdom. It chairs the Anglian Germ Cell Cancer Collaborative Group covering a population of 7.5 million in London and East of England and is a tertiary referral center for Germ Cell Tumors.
The surveillance protocol for patients, either with Stage 1 or metastatic tumors, who have undergone treatment is detailed below.
Surveillance is more frequent in the first two years post-treatment when relapses are more common. Blood pressure and weight are annually measured. At the five- and ten-year time points, hormone and lipid profiles are also measured.
In this analysis, Dr. Shamash and colleagues retrospectively reviewed the chart of patients with Stage 1 and metastatic germ cell tumors from the Saint Barthlomew's Health NHS Trust, between 2011 and 2021. Analysis was restricted to patients with a minimum follow-up of five years. Data was collected between years 3 and 10 following initial treatment (i.e., only starting two years following surveillance completion). The following data was collected:
- Relapse or recurrence rates beyond two years of treatment, divided by stage of disease (stage 1 versus metastatic) and receipt of adjuvant treatment in stage 1 disease
- Frequency of survivorship terminology appearing in clinical documentation
The investigators identified 721 patients meeting the eligibility criteria. At diagnosis, 396 patients had stage 1 disease and 325 had metastatic cancer. Of the 396 patients with Stage 1 disease, 171 (43.2%) received adjuvant treatment and 225 (56.8%) underwent surveillance alone. The relapse rates are summarized below. Significantly, none of the patients who received adjuvant treatment relapsed in the measured time period (i.e., beyond two years of follow-up).
Compared to those undergoing observation following an orchiectomy, those receiving treatment (either adjuvant or for metastatic disease), were more likely to report endocrinologic issues. There were no differences in blood pressure and cholesterol. Fertility issues were more commonly reported in the group who received treatment for metastatic cancer, compared to Stage 1 patients (observation or adjuvant). Survivorship issues appeared with consistent frequency throughout years 3 – 10 of treatment.
Dr. Shamash concluded that:
- Relapse rates of germ cell tumors are low beyond two years post-treatment.
- However, multiple survivorship issues for patients who received treatment consistently appear throughout years 3 – 10 of follow-up.
- These results strongly suggest the need to incorporate monitoring of survivorship issues into routine follow-up to improve patient experiences and outcomes.
- His group suggested the establishment of a monthly specialist clinic focused on addressing long-term survivorship issues for this patient population. This could be managed by an oncologist or advanced nurse practitioner, and ideally outside of hours to accommodate the younger working population.
Presented by: Jonathan Shamash, MB, ChB, Consultant Oncologist, St Barthlomew's Hospital, London, UK
Written by: Rashid Sayyid, MD, MSc – Society of Urologic Oncology (SUO) Clinical Fellow at The University of Toronto, @rksayyid on Twitter during the 2024 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, San Francisco, CA, January 25th – January 27th, 2024