A Review of the diagnosis, treatment and outcomes for Adolescents and Young Adults with testicular Germ Cell Tumours in Queensland from 2017 to 2023

Abstract

Cancer remains the leading cause of non-accidental death in Adolescents and Young Adults AYA (15-24 years) with an average of 230 new cancer diagnoses in Queensland each year (QCCAT). Germ cell tumours (GCT) affect 12% of the AYA population in Queensland and are the most common cancer affecting males in this cohort. Overall survival for testicular GCT (tGCT) is excellent, however, patients in the AYA population fare significantly worse compared to their younger and older counterparts, despite cancer clinical trials (CCTs) being available. The AYA cohort is heavily underrepresented in CCTs, compared to pediatric and adult cohorts, resulting in slow progress in improving survival rates, prevention of collection of valuable biospecimens, and poorer outcomes. We reviewed the epidemiology of AYA diagnosed with GCT in Queensland between 2017-2023 and aimed to evaluate the incidence, referral pathways, treatment, surveillance, and outcomes of these patients, with particular interest in clinical trial participation. During this time period, Queensland hospitals had open trials for good-, intermediate-and poor-risk GCT as well as a trial for relapsed/refractory patients. We analysed our findings in the context of evidence-based best practise to identify opportunities to improve the standard of care to AYAs with tGCT in Queensland. A cohort of 193 AYA non-CNS GCT patients (171 males and 22 females) was defined via an initial search of the Queensland Oncology Repository (QOR), a statewide clinical database collating patient demographics, cancer diagnosis and treatment information. 164 of 171 AYA males had testicular primary germ cell tumours. 88 patients (54%) presented with stage 2 or 3 disease. 56 patients presented with metastatic disease, and 83 patients had lymphovascular invasion (37% and 49%, respectively). At present, 3 or 4 cycles of BEP (bleomycin, etoposide, cisplatin) is considered standard of care (SOC), depending on risk. In those patients that received chemotherapy (n=105) only 67% (n=70) received SOC, which demonstrates inconsistencies in the treatment of AYAs with GCT. These findings have prompted a review of referral pathways and treatment schedules for tGCT in Queensland to understand if there are any reversible delays, system barriers and patient education that can be addressed. The P3BEP trial was open at three quaternary hospitals and AGCT1531 trial was open at one hospital. The enrolment rate across these three hospitals was 57% (8 of 14 patients). Therefore, this is evidence that AYAs offered to participate in a trial are likely to enrol.