title: Effective salvage chemotherapy with etoposide, dactinomycin, and methotrexate in refractory germ cell cancer. Australasian Germ Cell Trial Group.
abstract: Fifty-one patients with advanced germ cell malignancy who had either failed to achieve complete remission with initial cisplatin, vinblastine, and bleomycin chemotherapy or who had relapsed after complete response (CR) to this therapy and then proven refractory on retreatment, were treated with etoposide (75 mg/m2 for 3 days), dactinomycin (1 mg/m2 day 1), and methotrexate (30 mg/m2 day 1) (EAM) every 3 weeks. Courses were continued until maximum response without empirical limit, and if complete remission was achieved, two courses of consolidation therapy were given before cessation of treatment. Thirteen patients (25%) were complete responders with residual masses containing fibrosis or benign teratoma being subsequently resected in seven patients. Two patients had persisting viable carcinoma within residual masses that were completely resected, leaving no evidence of disease (NED); the combined CR plus NED rate was 29%. The only pretreatment factor significantly influencing this response rate was tumor volume. Toxicities were moderate, with leukopenia being observed in 28% of patients, but it was severe in only 2%. There was one death from septicemia. Severe nausea and vomiting occurred in only 9% of patients and treatment-related stomatitis was observed in 42%. All patients achieving CR plus NED have been followed for a minimum of 5 years and no relapses have occurred, suggesting that these patients are cured. Unlike other regimens of salvage chemotherapy, this treatment program did not contain cisplatin and it is contended that a completely noncrossresistant drug regimen based on etoposide provides the opportunity to further improve the curability of patients with advanced germ cell cancer.
authors: Department of Clinical Oncology, Royal North Shore Hospital of Sydney, Australia.
authors: J A
authors: JA
authors: Levi
authors: D
authors: D
authors: Thomson
authors: V
authors: V
authors: Harvey
authors: G
authors: G
authors: Gill
authors: D
authors: D
authors: Raghavan
authors: M
authors: M
authors: Tattersall
authors: R
authors: R
authors: Snyder
authors: I
authors: I
authors: Burns
authors: T
authors: T
authors: Sandeman
authors: M
authors: M
authors: Byrne
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003609:Dactinomycin / Q000008:administration & dosage / Q000009:adverse effects; D004341:Drug Evaluation; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000188:drug therapy*; D009373:Neoplasms, Germ Cell and Embryonal / Q000150:complications / Q000188:drug therapy*; D012074:Remission Induction; D013280:Stomatitis / Q000139:chemically induced / Q000453:epidemiology; D013736:Testicular Neoplasms / Q000150:complications / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D003609:Dactinomycin; D005047:Etoposide; D008727:Methotrexate