Germ cell cancer of the testis

Publications confirming a higher incidence of testicular germ cell cancer (GCC) in offspring of dizygous than in monozygous pregnancies and following pregnancies associated with severe maternal nausea show that transplacental-acting estrogen damage to fetal germ cells is becoming established as a major epidemiologic risk factor for these tumors. Endogenous retrovirus expression in GCC is a new observation that, given the confirmation that a high-frequency recessive gene was the best-fitting genetic model of familial GCC, opens up new areas for epidemiologic research. With two papers confirming the importance of excess p53 expression in determining GCC chemotherapy response, particularly in seminoma, the question of whether seminoma should be treated with different chemotherapy strategies re-emerges. Preclinical data on oxaloplatin suggest that it is active in cisplatin-resistant tumors, and justifies further trials to reduce our dependence on cisplatin. These trials will be difficult to undertake given the long time taken to prove the poor results from use of carboplatin--which 12 years after launch has now been shown to be 17% worse at 3 years in combination with bleomycin and etoposide.