Dr King on Teratoma in Residual Nonretroperitoneal Disease After Chemotherapy for Testicular Cancer

Jennifer M. King, MD, assistant professor, clinical medicine, Department of Medicine, Division of Hematology/Oncology, Indiana University (IU) School of Medicine, physician-scientist, IU Melvin and Bren Simon Comprehensive Cancer Center, discusses results from a retrospective study on the prevalence of teratoma and active germ cell tumors in patients who have residual nonretroperitoneal (non-RP) disease following chemotherapy for nonseminomatous germ cell tumors, and what these findings indicate about the need for surgical resection in this patient population.

The standard treatment approach for patients with advanced nonseminomatous germ cell tumors is a combination chemotherapy and surgical resection of residual disease as needed. Most patients who receive either first-line or salvage chemotherapy will have both residual non-RP disease and residual RP disease. However, a rare subset of patients will only display non-RP disease. There is a lack of guidance for the selection of surveillance strategies vs resection in this population, which can contribute to a higher treatment burden.

A retrospective review was conducted to assess whether there was an association between teratoma in the primary tumor and a greater probability of teratoma in this population with resected residual disease, King begins. The Indiana University testicular cancer database was utilized to identify a total of 129 patients with non-RP residual disease post-chemotherapy without residual RP disease. Of these patients, 75 had teratoma in the primary tumor site, she reports. Further analysis showed that 55% of patients with primary tumor teratomas had at least one post-chemotherapy non-RP surgical specimen with teratomatous elements after resection vs 17% of patients without teratoma in the primary tumor, King says. Notably, 56% of patients without teratoma in the primary tumor had active germ cell tumor at the time of surgical resection vs 31% of those with teratoma in the primary tumor, King emphasizes. This occurred regardless of the location of the resected residual non-RP disease.

Overall, both groups of patients had comparable rates of teratoma or active germ cell tumor in residual non-RP disease, King continues. This indicates that the presence or absence of primary tumor teratoma cannot definitively guide management decisions in this space, she states. More specifically, a lack of teratoma in the primary tumor should not preclude resection for these patients, King concludes.