Gas cost 53 cents a gallon, pocket calculators made their debut, and most men with testicular cancer died from their disease.
That was 40 years ago.
But in 1974, a young medical oncologist, Lawrence H. Einhorn, M.D., who was new to Indiana University, tested the platinum-based drug Cisplatin with two additional drugs that were effective in killing testis cancer cells. The combination became the cure for this once deadly disease.
Young men had already been traveling to then-Indiana University Hospital in the early 1970s because John Donohue, M.D., offered radical surgery that other urologic surgeons would not perform. He was the acknowledged world leader in the surgical cure for early-stage testicular cancer and achieved a 20 percent survival rate when the disease had spread to the abdomen. However, when cancer cells had traveled beyond the reach of the surgical knife, testis cancer resulted in a uniformly fatal prognosis.
In 1973, Dr. Donohue welcomed the addition of Dr. Einhorn to the IU School of Medicine faculty. He was the school’s first medical oncologist, and his expertise in cancer drug therapy complemented Dr. Donohue’s surgical proficiency. Together they treated more metastatic testis cancer cases than anyone else in the world.
As a 32-year-old oncologist, Dr. Einhorn often was face-to-face with young men with this terminal disease. He dedicated himself to developing a better chemotherapy-based treatment, truly believing that it was incumbent upon him to improve the overall 5 percent survival rate.
Within a year of his arrival at IU, he would test Cisplatin. The platinum-based drug had failed in a Phase I clinical trial with patients who had various end-stage cancers, including testis cancer. Cisplatin was found to be too toxic, causing severe vomiting, neuropathy, hearing loss and kidney damage in these patients, and it failed to stop the growth and spread of most of the cancers. But Dr. Einhorn was intrigued by the disease regression experienced by a very small number of testis cancer patients in the trial and developed a strategy to combine Cisplatin with two additional drugs that also were effective in killing testis cancer cells. His goal was to increase the likelihood of a longer remission in testis cancer patients.
The results of this three-drug regimen were stunning. Tumors dissolved within days. Subsequent clinical research directed by Dr. Einhorn minimized the extremely toxic side effects of treatment; shortened the duration of two years of therapy to nine to 12 weeks; and established a model for a curable tumor, which has served as a research roadmap for generations of oncologists.
Surgical advancements also followed in the 1980s when Dr. Donohue developed a nerve-sparing surgical technique that allowed men to maintain quality of life and, almost always, reproductive capabilities. Today remission and recovery rates are so high and relapse rates so low that 95 percent of all patients are cured. This is the highest success rate of any cancer.
Dr. Donohue died in 2008, but his legacy and Dr. Einhorn’s achievements endure. Chemotherapy -- instead of radical surgery -- is now first-line therapy for advanced testicular cancer, and radical surgeries have given way to nerve-sparing techniques. Together these outstanding physician researchers solidified Indiana University’s reputation as the indisputable leader in testicular cancer research, treatment and education worldwide.
With more than 300,000 testis cancer survivors worldwide, Dr. Einhorn is committed to reducing the “burden of cure” for these men who live with hearing loss, neuropathy and heart disease as a result of treatment. While research continues for the 5 percent of patients who succumb to testis cancer, new investigations are also focused on reducing the toxic side effects of treatment. And more than 5 million patients with 12 different cancers receive Cisplatin annually.
Many of the resources necessary to initiate this program are at Indiana University. IU is home to the most extensive database of testicular cancer patient outcomes anywhere, an extraordinary survivorship resource reflecting Drs. Donohue and Einhorn’s foresight and commitment to research.
IU is also home to unique expertise in personalized medicine that focuses on genetic risks for side effects of drug therapy. In fact, researchers with the Indiana Institute for Personalized Medicine -- led by David Flockart, M.D., PhD. -- work to bridge the gap between genomics research and patient care. Blending genetic data from both tumor and patient will lead to the development of the new “platinum” standard of future treatments and will guide lifelong health management for survivors.
