title: Cisplatin, etoposide, ifosfamide, vincristine and bleomycin combination chemotherapy for far advanced testicular carcinoma.
abstract: Forty-eight patients with advanced testicular cancer, defined as abdominal mass greater than 10 cm, mediastinal mass greater than 5 cm, more than 20 lung metastases, or visceral organ involvement were treated with an intensive, alternating five-drug regimen consisting of cisplatin 50 mg/m2 d 1-3, etoposide 170 mg/m2 d 1-3, ifosfamide 5 g/m2 d 15, vincristine 2 mg weekly, bleomycin 15 mg/m2 weekly, q d 28. Thirty-four (71%) of the patients attained tumor-free status. This was achieved by chemotherapy alone in 14 patients and by surgical resection of residual disease in the remaining 20 patients (histology of resected tissue: necrosis 12, mature teratoma 7, viable carcinoma 1). Patients with pure seminoma responded better than patients with nonseminoma (CR 100% vs. 67%, respectively). In a univariate analysis only the value of HCG (less than vs greater than 10,000 U/L) and the number of involved organ sites (less than or equal to 2 vs greater than to 2) had significant influence on the response rate. After a minimum follow-up of 24 months 3 patients (9%) have relapsed. The survival rate is 76% after 36 months, with 61% remaining disease-free. Though this intensive regimen might bestow some of the therapeutic advantages of standard three-drug protocols in far advanced testicular cancer, the results are still less than optimal and warrant the exploration of new therapeutic strategies.
authors.affiliation: University of Hannover, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Harstrick
authors.forename: H J
authors.initials: HJ
authors.lastname: Schmoll
authors.forename: C H
authors.initials: CH
authors.lastname: Köhne-Wömpner
authors.forename: L
authors.initials: L
authors.lastname: Bergmann
authors.forename: U
authors.initials: U
authors.lastname: Lammers
authors.forename: J
authors.initials: J
authors.lastname: Hohnloser
authors.forename: G
authors.initials: G
authors.lastname: Dölken
authors.forename: P
authors.initials: P
authors.lastname: Reichhardt
authors.forename: W
authors.initials: W
authors.lastname: Siegert
authors.forename: F
authors.initials: F
authors.lastname: Natt
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004407:Dysgerminoma / Q000188:drug therapy / Q000401:mortality / Q000556:secondary; D005500:Follow-Up Studies; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000401:mortality / Q000556:secondary; D012074:Remission Induction; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000401:mortality; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D001761:Bleomycin; D014750:Vincristine; D002945:Cisplatin; D007069:Ifosfamide