title: The role of ifosfamide plus cisplatin-based chemotherapy as salvage therapy for patients with refractory germ cell tumors.
abstract: A prospective study of four cycles of etoposide with ifosfamide and cisplatin (VIP) chemotherapy was conducted in 42 germ cell tumor (GCT) patients who were refractory to cisplatin with etoposide/vinblastine-based therapy. Forty patients were evaluable for response. Ten patients (25%) had a complete response: seven to chemotherapy alone and an additional three patients after surgical resection of viable GCT. With a median follow-up of 15 months, four complete responders relapsed, and six patients (15%) remain in remission. Hematologic and nephrotoxicity were moderately severe. Durable complete responses with VIP as second salvage were achieved and suggests that ifosfamide adds efficacy to standard first-salvage therapy. The observed nephrotoxicity and myelotoxicity are considerations in the design of ifosfamide-cisplatin-based regimens. Hematopoietic growth factors may be useful in ameliorating myelotoxicity. The early use of ifosfamide-based chemotherapy may reduce the nephrotoxicity exacerbated by prior cisplatin. A trial of VIP as first salvage after a relapse from a complete response to platinum-based induction therapy is warranted. The modest proportion of patients who achieve a durable remission to VIP as second salvage emphasizes the need for more efficacious salvage therapy for patients who do not achieve a durable complete response.
authors.affiliation: Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: R J
authors.initials: RJ
authors.lastname: Motzer
authors.forename: K
authors.initials: K
authors.lastname: Cooper
authors.forename: N L
authors.initials: NL
authors.lastname: Geller
authors.forename: D F
authors.initials: DF
authors.lastname: Bajorin
authors.forename: E
authors.initials: E
authors.lastname: Dmitrovsky
authors.forename: H
authors.initials: H
authors.lastname: Herr
authors.forename: M
authors.initials: M
authors.lastname: Morse
authors.forename: W
authors.initials: W
authors.lastname: Fair
authors.forename: P
authors.initials: P
authors.lastname: Sogani
authors.forename: P
authors.initials: P
authors.lastname: Russo
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D011446:Prospective Studies; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology
chemical_list: D005047:Etoposide; D002945:Cisplatin; D007069:Ifosfamide