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GU Cancers 2026 | CLIMATE: miR-371 as an MRD marker in stage 1 testicular cancer

Ben Tran, MBBS, FACP, Peter MacCallum Cancer Centre, Melbourne, Australia, discusses initial results from the CLIMATE prospective cohort study (ACTRN12622000247774) evaluating circulating miR-371 as a minimal residual disease (MRD) marker in clinical stage 1 testicular germ cell tumor patients on active surveillance. The analysis demonstrated that detectable post-orchiectomy miR-371 showed superior discriminatory accuracy for predicting recurrence compared to existing biomarkers. This novel biomarker showed promise for guiding adjuvant chemotherapy decisions in this patient population undergoing surveillance management. This interview took place at the 2026 ASCO GU Cancers Symposium in San Francisco, CA.

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Transcript

So in stage one testicular cancer, we know this is highly curable. The current standard of care would be active surveillance, but some patients do undergo adjuvant chemotherapy, those patients with the highest risk of recurrence. The problem is even in those with the highest risk of recurrence, the use of adjuvant chemotherapy leads to unnecessary treatment and toxicity in the majority of patients...

So in stage one testicular cancer, we know this is highly curable. The current standard of care would be active surveillance, but some patients do undergo adjuvant chemotherapy, those patients with the highest risk of recurrence. The problem is even in those with the highest risk of recurrence, the use of adjuvant chemotherapy leads to unnecessary treatment and toxicity in the majority of patients. So what we need are better biomarkers that can predict recurrence. And one of those biomarkers could be microRNA 371. So the clinical study went about understanding if microRNA 371 can predict recurrence. And so we enrolled 200 patients from Australia and New Zealand across 12 sites and we recruited them and they underwent active surveillance for stage one testicular cancer. They had blood tests looking for microRNA 371 at baseline and then every three months, for the first couple of years. And today we reported our interim analysis. So these interim results looked at whether a baseline microRNA 371 could predict recurrence. We looked at the positive and negative predictive value and also compared a plasma versus serum assay. And what we found in this interim analysis was that the plasma assay was superior to serum and that yes, in fact, a microRNA 371 at baseline just after orchiectomy can predict for recurrence with a hazard ratio of 10.3, p-value, highly significant, less than 0.001. What we found at 24 months was that the recurrence-free rate in those who were positive was 32%, but in those who were negative was 89%. So it clearly stratifies for recurrence. And so what we hope in the next step is can we design the studies that can demonstrate that those who are positive do need adjuvant chemotherapy.

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