A rare case of advanced testicular seminoma in a 78-year-old man managed successfully with carboplatin based chemotherapy: a case report

Ismaili, Nabil; Naciri, S.; Afqir, Saïd; Mellas, Nawfel; Bekkouch, I.; Elmajjaoui, Sanaa; Masbah, O.; Othmani, Nazih; Fléchon, Aude; Droz, Jean Pierre; Errihani, Hassan

doi:10.1186/1757-1626-1-357

Cited by 11 publications

(14 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Information is scarce in the available literature regarding the clinical outcome of older patients with malignant germ cell tumours in the era of platinum‐based chemotherapy, with just a few case reports of successful treatment [9–11]. A recent pathological review [2] of 50 germ cell tumours in the elderly (median age 67 years) found that most were seminomas (82% compared to the 73% reported in the series of the present study); however, complete information about staging or outcome was not given.…”

Section: Discussionmentioning

confidence: 68%

The clinical features and management of testicular germ cell tumours in patients aged 60 years and older

Wheater¹,

Manners²,

Nolan³

et al. 2011

BJU International

View full text Add to dashboard Cite

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject ? and What does the study add? The treatment of younger men with testicular germ cell cancers is well documented with established intensive chemotherapy regimens for those with advanced disease. Although the majority of patients present in the third or fourth decade, men also present in later life. These patients are typically excluded from clinical trials and there are no contemporary published series describing their management. This series describes the management of older patients with testicular germ cell tumours at both early and advanced stages of disease. Patients with stage I seminoma can be safely managed with all recognised treatment strategies and state I non‐seminomas were managed with surveillance. Cure can still be achieved in older patients with advance germ cell tumours however chemotherapy regimens developed in younger patients must be tailored to the presence of co‐morbidity. OBJECTIVES • To review the practice of a large referral centre for the management of older patients with testicular germ cell cancer (GCC). • There are few published data available on the management of testicular GCC in elderly patients, who often have medical comorbidities and have been excluded from clinical trials. PATIENTS AND METHODS • We reviewed our prospectively collected database for patients presenting with GCC who were aged ≥60 years. • Details of presentation, management and outcome were recorded. RESULTS • In total, 60 patients aged ≥60 years were identified from 1461 patients treated with GCC from 1979–2005, representing 4% of the total population. • Median age was 67 years, 44 had seminoma (73%) and 16 had non‐seminoma histology (27%). • Stage I seminoma patients were managed with surveillance, adjuvant radiotherapy and adjuvant carboplatin. All stage I non‐seminomas underwent surveillance. • In total, 15 patients received systemic chemotherapy for metastatic disease with modified bleomycin, etoposide and cisplatin; etoposide and cisplatin; carboplatin‐based regimens; or other combinations. Toxicity was manageable, with no toxic deaths. • In total, four patients (6.7%) died of GCC. CONCLUSIONS • In elderly patients, GCC should be managed with curative intent. • Conventional therapies are tolerable for most men with stage I seminoma. In metastatic disease, comorbidity may necessitate treatment modifications. • Most patients are cured with manageable toxicity.

show abstract

Section: Discussionmentioning

confidence: 68%

The clinical features and management of testicular germ cell tumours in patients aged 60 years and older

Wheater¹,

Manners²,

Nolan³

et al. 2011

BJU International

View full text Add to dashboard Cite

show abstract

“…Testicular seminoma accounts for 40%–60% of all testicular germ cell tumors, which are the most common solid tumors in males aged 15–35 years. 1 , 2 Although the cure rate of testicular seminoma at stage I (nonmetastasized seminoma) exceeds 95%, there is a poor prognosis once the tumor spreads to adjacent lymph node groups (including those in the neck, mediastinum, and abdomen), lung, liver, and bones. 2 – 6 Epidemiological studies have indicated that cryptorchidism, gonadal dysgenesis, familial testis cancer, and environmental exposure to chemical substances increase the risk of seminoma occurrence; however, the precise molecular pathogenesis of seminoma is unclear.…”

Section: Introductionmentioning

confidence: 99%

TDRG1 functions in testicular seminoma are dependent on the PI3K/Akt/mTOR signaling pathway

Wang

Gan

Tan

et al. 2016

OTT

View full text Add to dashboard Cite

Human testis development-related gene 1 (TDRG1) is a recently identified gene that is expressed exclusively in the testes and promotes the development of testicular germ cell tumors. In this study, the role of TDRG1 in the development of testicular seminoma, which is the most common testicular germ cell tumor, was further investigated. Based on polymerase chain reaction, Western blotting, and immunohistochemistry tests, both gene and protein expression levels of TDRG1 were significantly upregulated in testicular seminoma tissues compared with normal testicular tissues. Additionally, the levels of phosphoinositide-3 kinase (PI3K)/p110 and Akt phosphorylation were dramatically upregulated in testicular seminoma tissues. Accordingly, in our cell experiment, seminoma TCam-2 cells were subjected to different treatments: the TDRG1 knockout, TDRG1 overexpression, PI3K inhibition (LY294002 administration), or PI3K activation (insulin-like growth factor-1 administration). Cell proliferation, the proliferation index, apoptosis rate, cell adhesive capacity, and cell invasion capability were assessed. Cells with both TDRG1 knockout and PI3K inhibition exhibited decreased cell proliferation, proliferation indexes, cell adhesion capacity, and cell invasion capability and increased apoptosis rates. Most of these effects were reversed by TDRG1 overexpression or PI3K activation, indicating that both TDRG1- and PI3K-mediated signaling promote proliferation and invasion of testicular seminoma cells. The knockout of TDRG1 significantly decreased the phosphorylation levels of PI3K/p85, PI3K/p110, Akt, and mammalian target of rapamycin (mTOR; Ser2448). Except for PI3K/p110, TDRG1 overexpression had the opposite effects on phosphorylation levels. Phosphorylated mTOR at Ser2481 and Thr2446 was not affected by TDRG1 or PI3K in our tests. Thus, these results indicate that TDRG1 promotes the development and migration of seminoma cells via the regulation of the PI3K/Akt/mTOR signaling pathway; this contributes to an understanding of the precise mechanisms underlying the development and migration of seminomas and lays a theoretical foundation for the development of appropriate therapies.

show abstract

“…Because carboplatin does not require hydration during administration and produces fewer toxic adverse events than cisplatin, it is an optimal anticancer drug for patients who do not tolerate cisplatin. [1][2][3][4][5] Although carboplatin is considered safe and easy to use, it can induce cardiotoxicity via a mitochondrial-dependent apoptosis pathway, and a case of cardiac failure caused by carboplatin has been reported. 14,15 Thus, carboplatin should be carefully administered to patients with cardiac disease despite the fact that carboplatin-induced cardiac disease occurs at a low frequency.…”

Section: Discussionmentioning

confidence: 99%

“…However, the relationship among the dose intensity, total number of cycles, and treatment outcome (including the rate of relapse) is very controversial. [4][5][6][7][8]16 Although there is no strict evidence for the efficacy of prolonged administration of carboplatin, including maintenance therapy, long-term carboplatin at 4 AUC may achieve therapeutic efficacy with minimal occurrence of serious adverse events.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] Although singleagent carboplatin therapy is effective for advanced testicular cancer in some patients, the optimal dose and duration for the maximum therapeutic response with minimal adverse effects are very controversial. [6][7][8] Additionally, few reports have described the safety of carboplatin for patients with cardiac complications, especially CHF.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Long-term administration of single-agent carboplatin (AUC 4) for advanced testicular seminoma safely achieved complete response in an 80-year-old man with chronic heart failure: A case report

Fukuhara

Yagi

Ando

et al. 2014

CUAJ

View full text Add to dashboard Cite

Cite as: Can Urol Assoc J 2014;8(11-12):e931-3. http://dx.doi.org/10.5489/cuaj.2089 Published online December 15, 2014. AbstractCarboplatin is often used instead of cisplatin as an alternative treatment for advanced testicular cancer. However, the safety, optimal dose, and optimal duration of this agent are unclear in patients with cardiac complications. We report the safety and effectiveness of long-term single-agent carboplatin for the treatment of testicular cancer in a patient with chronic heart failure (CHF). An 80-year-old man was referred to our institution for evaluation of painless swelling of the left scrotum. Computed tomography revealed lung metastases. Left radical inguinal orchiectomy was performed, and pathologic examination revealed a pure seminoma. Because he had CHF, there was high possibility of onset of acute heart failure secondary to fluid administration. Thus, single-agent carboplatin (AUC 4) was selected for therapy. A complete response was achieved after 8 of 13 cycles, and no serious adverse events occurred, including cardiac problems. Neither recurrence nor metastasis was detected during the 6-month follow-up. Low-dose, long-term carboplatin is likely effective for patients who are unfit for cisplatin administration because of comorbidities, especially CHF.

show abstract

A rare case of advanced testicular seminoma in a 78-year-old man managed successfully with carboplatin based chemotherapy: a case report

Abstract: Background: Germ cell tumours are uncommon in aged man. We present a rare case of metastatic seminoma of the testis associated with liver and renal insufficiencies in a 78-years-old man managed successfully with carboplatin based chemotherapy.

Cited by 11 publications

References 10 publications

The clinical features and management of testicular germ cell tumours in patients aged 60 years and older

The clinical features and management of testicular germ cell tumours in patients aged 60 years and older

TDRG1 functions in testicular seminoma are dependent on the PI3K/Akt/mTOR signaling pathway

Long-term administration of single-agent carboplatin (AUC 4) for advanced testicular seminoma safely achieved complete response in an 80-year-old man with chronic heart failure: A case report

Contact Info

Product

Resources

About