Curing metastatic testicular cancer
Curing metastatic testicular cancer
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DOI：
10.1073/pnas.072067999
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发表时间：
2002-04-02
影响因子：
11.1
通讯作者：
Einhorn, LH
中科院分区：
文献类型：
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作者：
Einhorn, LH
我们最初的顺铂+长春碱+博莱霉素研究始于27年前的1974年，将播散性疾病的治愈率从5%提高到60%。随后，通过随机前瞻性临床试验，我们修改了治疗方案，以减少化疗药物的持续时间和剂量。顺铂+依托泊苷于1978年首次在印第安纳州大学用作挽救性化疗，这是实体瘤首次通过二线化疗治愈。我们接下来进行了一项比较博来霉素+依托泊苷+顺铂（BEP）与顺铂+长春碱+博来霉素的临床试验。BEP方案被证明具有更低的毒性和更高的治愈率，因此自1984年以来一直是标准化疗。最近的研究已经评估了使用较少的化疗来维持预后良好疾病患者的相同治愈率。这些患者的标准治疗是三个疗程的BEP或四个疗程的EP，超过90%的这些患者将治愈他们的疾病。初始BEP化疗未治愈的患者通常采用补救化疗。这些睾丸癌患者中约有50%随后将通过补救化疗（高剂量化疗与外周干细胞补救的串联移植）治愈。睾丸癌已成为一种可治愈的肿瘤模型。在20世纪70年代早期，转移性睾丸癌的生存率仅为5%。今天，随着现代化疗和手术技术的发展，80%的患者可以在疾病中存活下来。
Our initial studies with cisplatin + vinblastine + bleomycin began 27 years ago in 1974, changing the cure rate for disseminated disease from 5 to 60%. Subsequently, through random prospective clinical trials, we have modified the treatment regimen to reduce both the duration and dosages of the chemotherapy drugs. Cisplatin + etoposide was first used at Indiana University as salvage chemotherapy in 1978, representing the first time that a solid tumor had been cured with second-line chemotherapy. We next did a clinical trial comparing bleomycin + etoposide + cisplatin (BEP) to cisplatin + vinblastine + bleomycin. The BEP regimen was proven to have less toxicity and a higher cure rate and therefore, since 1984, has been standard chemotherapy. More recent studies have evaluated the use of lesser chemotherapy to maintain the same cure rate for patients with good-prognosis disease. Standard therapy for these patients is either three courses of BEP or four courses of EP, and over 90% of these patients will be cured of their disease. Patients who are not cured with their initial BEP chemotherapy are usually treated with salvage chemotherapy. Approximately 50% of these testicular cancer patients will subsequently be cured with salvage chemotherapy with tandem transplant of high-dose chemotherapy with peripheral stem cell rescue. Testicular cancer has become a model for a curable neoplasm. In the early 1970s, metastatic testicular cancer was associated with only 5% survival. Today, with modern chemotherapy and surgery techniques, 80% of patients will survive their disease.