title: Treatment of high-risk, nonseminomatous testicular cancer with cisplatin, ifosfamide and bleomycin: long-term results.
abstract: Thirty-four patients with stage IIC (unresectable, retroperitoneal tumor mass (RTM) greater than 5 cm), stage IVC (minimal lung metastases less than 10 cm3 and RTM greater than 5 cm) and IVD (lung metastases greater than 10 cm3 and RTM greater than 5 cm), who had not received previous chemotherapy, were treated with cisplatin (40 mg/m2, on days 2-4), ifosfamide (5 g/m2, on days 1 and 5) and bleomycin (30 mg, on days 1, 8, 15) (PIB), every 21 days. Twenty of the 34 patients (59%) achieved a complete remission (CR). Furthermore, five patients (15%) showed no evidence of disease (NED) after surgical removal of residual tumor masses (NED rate of 74%). A tumor marker-negative partial remission (PR) occurred in 3/34 patients (9%), and a tumor marker-positive PR in another 3/34 patients (9%). Three patients did not respond to this regimen. At a median follow-up period of 38 months (range, 15-47 months), 26/34 patients (76%) were alive, 21 (62%) of them without evidence of disease and three with a stable tumor marker-negative remission. Major toxicity consisted of myelosuppression, neurotoxicity and nephrotoxicity. Chemotherapy-related mortality occurred in two patients (one septicemia and one bleomycin-induced lung fibrosis). In conclusion, PIB is an effective induction regimen in patients with high-risk NSTC. However, controlled clinical trials are necessary to prove the superiority of dose intensification schedules.
authors.affiliation: Department of Internal Medicine, West German Tumor Center, University of Essen.
authors.forename: U B
authors.initials: UB
authors.lastname: Wandl
authors.forename: K
authors.initials: K
authors.lastname: Günzel
authors.forename: R
authors.initials: R
authors.lastname: Kath
authors.forename: M E
authors.initials: ME
authors.lastname: Scheulen
authors.forename: J
authors.initials: J
authors.lastname: Hayungs
authors.forename: K
authors.initials: K
authors.lastname: Höffken
authors.forename: S
authors.initials: S
authors.lastname: Seeber
authors.forename: N
authors.initials: N
authors.lastname: Niederle
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D002986:Clinical Trials as Topic; D004407:Dysgerminoma / Q000188:drug therapy / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000473:pathology
chemical_list: D001761:Bleomycin; D002945:Cisplatin; D007069:Ifosfamide