High-risk germ cell tumors in men. High response rate and severe toxicity with cisplatin, vinblastine, bleomycin, and etoposide.
BACKGROUND
In an attempt to improve the complete remission and cure rate of advanced, bulky, high-risk germ cell cancer in men, a "high-dose" cisplatin, vinblastine, bleomycin, and etoposide (PVeBV) regimen was introduced.


METHODS
Ten men with biopsy-proven germ cell tumors who had one or more poor prognostic features were treated with PVeBV.


RESULTS
Six of the 10 had complete remissions and are long-term survivors. The most devastating toxicity, which resulted in the death of three patients, was progressive respiratory failure. It was postulated that renal tubular injury prolonged the renal clearance of bleomycin, intensifying the patient's pulmonary exposure to this drug and increased the susceptibility to pulmonary injury at lower than expected cumulative doses of bleomycin.


CONCLUSIONS
Modifications of the regimen to reduce toxicity without diminishing the efficacy should be considered before PVeBV is adopted for general use.
Blayney
D W
DW
Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, California.
Goldberg
D A
DA
Leong
L A
LA
Margolin
K A
KA
Burke
J S
JS
Doroshow
J H
JH
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage / Q000009:adverse effects; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000556:secondary; D012307:Risk Factors; D014747:Vinblastine / Q000008:administration & dosage / Q000009:adverse effects
D001761:Bleomycin; D014747:Vinblastine; D005047:Etoposide; D002945:Cisplatin