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Department of Medical Oncology, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands.

PURPOSE: After cisplatin- and bleomycin-containing chemotherapy for testicular cancer, part of the patient population will develop acute or long-term cardiovascular toxicity. It is largely unknown whether standard tests can be used to assess chemotherapy-induced cardiovascular changes. PATIENTS AND METHODS: In 65 testicular cancer patients (median age, 27 years; range, 18 to 48 years), we measured the following cardiovascular parameters before and within 10 weeks after completion of cisplatin-based chemotherapy: platelet numbers, plasma levels of hemostatic and fibrinolytic factors, 24-hour ambulatory blood pressure, baroreflex sensitivity, intima-media thickness of the common carotid artery, and flow-mediated vasodilation of the brachial artery. RESULTS: Compared with prechemotherapy values, the intima-media thickness of the carotid artery and plasma von Willebrand factor levels increased significantly after treatment. Platelet numbers and plasma levels of other hemostatic and fibrinolytic factors did not appear to change significantly. Blood pressure decreased significantly, but flow-mediated vasodilation and baroreflex sensitivity did not change. CONCLUSION: In testicular cancer patients treated with cisplatin-based chemotherapy, we found an increase in plasma von Willebrand factor levels and in the intima-media thickness of the carotid artery. These changes may indicate chemotherapy-induced vascular damage and be of prognostic significance for the development of cardiovascular complications in the long term.

Trial 1
Identification of the genetic causes of testicular cancer.
A small number of men who have testicular cancer have a relative who has also been diagnosed with testicular cancer. This is because their cancer is caused by a very rare inherited fault in their genes.

The risk factors for testicular cancer include a family history or having an undescended testicle (cryptorchidism). In this study, the researchers will look at the genes of men with a family history of testicular cancer or an undescended testicle. You can take part in this study if 2 members of the family have been diagnosed with testicular cancer or have an undescended testicle.

We already know about one suspected gene that increases a man's risk of developing testicular cancer, but think there are more. The first aim of this study is to find out more about these genes.

The second aim of this study is to find out if men with a family history of testicular cancer are more likely to develop any other cancer.

Trial 2
Chemotherapy for testicular cancer (TE3)
The standard chemotherapy for testicular cancer is a combination of bleomycin, etoposide and cisplatin. This is usually called BEP chemotherapy.

BEP works very well for testicular cancer, and many patients are cured. But bleomycin can cause serious side effects in a small number of patients. It can damage the lung tissue and cause shortness of breath. If this happens the doctors may need to lower the dose of bleomycin, or even change to another drug.

Researchers think that giving bleomycin more slowly may reduce the risk of it causing lung damage. In this trial, they will compare bleomycin given over half an hour on 3 separate days (standard treatment), to a slow continuous infusion of bleomycin 24 hours a day, for 3 days.

The aim of this trial is to find out if giving bleomycin continuously for 3 days causes fewer side effects than giving the same dose over a shorter time on 3 separate days. And to see which treatment works better.

Trial 3
Chemotherapy for male germ cell cancer (TE 23)
Germ cells are the cells that produce eggs in females and sperm in males. Male germ cell cancers usually develop in the testicles, but can be found in other parts of the body.

Doctors usually treat germ cell cancers with surgery if it is in the testicle, or chemotherapy if it is somewhere else in the body. They usually give a combination of chemotherapy called BEP. This is bleomycin, etoposide and cisplatin.

BEP doesn't always work well for germ cell cancers that are classed as 'poor prognosis'. Doctors think a new combination of drugs known as CBOP BEP may work better for these cancers. CBOP BEP is carboplatin, vincristine, bleomycin, etoposide and cisplatin. But all chemotherapy drugs have some side effects, and it is important that patients don't have treatments they don't need.

The aim of this trial is to compare BEP and CBOP BEP to see which works better for poor prognosis male germ cell cancer. And to find out more about the side effects.