(UroToday.com) The 2024 ESMO annual meeting included a session on testicular cancer, featuring a presentation by Dr. Axel Heidenreich discussing the 3 year update of the prospective COTRIMS trial. Both radiation or chemotherapy represent the standard treatment in clinical stage IIA/B seminoma. Despite high cure rates, both modalities are associated with significant long-term toxicities. The COTRIMS trial evaluated the oncological and functional efficacy of primary retroperitoneal lymphadenectomy (RPLND) without adjuvant chemotherapy in clinical stage IIA/B seminomas.
There were 34 patients with clinical stage IIA/B pure seminoma prospectively recruited for the COTRIMS trial. Exclusion criteria were:
- Adjuvant chemotherapy following orchiectomy
- Clinical stage IIC
- Previous retroperitoneal surgery or radiation
- Positive tumor markers
All patients underwent nerve sparing RPLND (31 open; 3 robotic) with a unilateral template, and no adjuvant chemotherapy was delivered. Follow-up was done according to EAU guidelines. In 22 patients, mir371 was evaluated preoperatively and correlated with histopathology of the lymph nodes.
The median age was 34.2 (range: 21-54) years, and the mean and median follow-up was 41.5 (SD 4-73) and 33.4 (range: 13-56) months, respectively. Overall, 22 and 12 patients had clinical stage IIA and clinical stage IIB, respectively:
The mean operative time, blood loss, and hospitalization were 131 (SD 105-195) min, 150 ml (SD 50 – 290), and 4.5 (SD 3-9) days, respectively. Four (11.7%) patients experienced Clavien Dindo 3a complications, and antegrade ejaculation was preserved in 88% of men. A mean of 19 (SD 7-57) lymph nodes were dissected, the mean number of positive lymph nodes was 1.4 (SD 1-2), and the mean diameter was 2.3 (SD 0.8-4.1) cm. Seminoma was present in 88.9% of specimens and 11.7% had no seminomatous metastases. miR371 was positive in 17/18 patients with metastases und negative in 3/3 with benign lesions. Overall, 4 (11.7%) patients relapsed after 4, 6, 9 and 12 months, and all were salvaged by chemotherapy. Relapse- and intervention-free survival are as follows:
Dr. Heidenreich concluded his presentation by discussing the 3-year update of the prospective COTRIMS trial with the following take-home points:
- RPLND results in high cure rates associated with low frequency of surgery–related complications even after a follow-up of 3 years
- Nearly 90% of patients can be managed without systemic chemotherapy
- RPLND should be included in the treatment options for clinical stage IIA/B seminomas
- miR371 appears to be a valid biomarker to predict presence of lymph node metastases
- The results of current prospective trials are summarized:
Presented by: Axel Heidenreich, MD, University Hospital Cologne, Köln, Germany
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2024 European Society of Medical Oncology (ESMO) Annual Meeting, Barcelona, Spain, Fri, Sept 13 – Tues, Sept 17, 2024.
Related Content: COTRIMS Trial Shows High Cure Rates with RPLND in Stage IIA/B Seminoma - Axel Heidenreich