AUTHOR=Wood Georgina E. , Bunting Christopher P. , Veli Mesel , Arora Rupali , Berney Daniel M. , Alifrangis Constantine , MacDonald Nicola D. , Miller Rowan E. , Shamash Jonathan , Stoneham Sara , Lockley Michelle 

TITLE=Seminoma and dysgerminoma: evidence for alignment of clinical trials and de-escalation of systemic chemotherapy

JOURNAL=Frontiers in Oncology

VOLUME=Volume 13 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2023.1271647

DOI=10.3389/fonc.2023.1271647

ISSN=2234-943X

ABSTRACT=Malignant germ cell tumours are a group of rare cancers whose incidence peaks in late adolescence and early adulthood. Dysgerminomas of the ovary and seminomas of the testis are analogous diseases but seminomas have a 10-fold higher incidence. The two tumours are morphologically identical and are only differentiated by surrounding organ-specific tissue or testicular germ cell neoplasia in situ. They share genetic features including KIT and RAS mutations, amplification of chromosome 12p and expression of pluripotency markers (NANOG, OCT3/4 and SAL4). Both histologies are exquisitely sensitive to platinum chemotherapy and the combination of bleomycin, etoposide and cisplatin (BEP) yields survival rates greater than 90%. However, BEP causes significant, lifelong toxicity (cardiovascular, renal, respiratory, neurological) in these young patients with an expectation of cure. Here we comprehensively review the biological features of dysgerminoma and seminoma to demonstrate that they are biologically analogous diseases. We present available clinical trial data supporting de-escalation of chemotherapy treatment. Finally, we propose that future trials should enrol men, women and children to benefit all patients regardless of age or sex.