Cisplatin and ifosfamide with either vinblastine or etoposide as salvage therapy for refractory or relapsing germ cell tumor patients: the Institut Gustave Roussy experience.
BACKGROUND
Approximately 30% of patients with metastatic germ cell tumors require salvage chemotherapy for recurrent or refractory disease after first-line treatment. The optimal salvage chemotherapy regimen remains to be determined.


METHODS
Fifty-four patients with metastatic germ cell tumors who failed to be cured with first-line therapy, were treated with a salvage VIP/VeIP regimen including cisplatin (20 mg/m2/d dl to d5), ifosfamide (1.2 gm/m2/d dl to d5), and either etoposide (75 mg/m2/d dl to d5) or vinblastine (0.11 mg/kg/d dl and d2) for 5 consecutive days every 3 weeks.


RESULTS
A complete remission was observed in 24 patients (44%) at completion of VIP/VeIP chemotherapy. In 17 patients (31%), complete remission was reached with chemotherapy alone, whereas four (7%) were rendered tumor-free by resection of the residual inactive tumor. Three patients (6%) became tumor-free by resection of the residual carcinoma. Ten other patients (19%) achieved a partial response, with normalization of serum tumor markers. Eleven of those thirty-four patients additionally received high-dose chemotherapy with hematopoietic stem cell support as consolidation treatment. Twenty patients (37%) were judged to be treatment failures because of either incomplete response (3 patients) or progression of disease (17). Myelotoxicity was severe, but no toxicity deaths were noted. After a median follow-up of 30 months, 23 patients (43%) are alive, 16 of whom (30%) are without evidence of progression of disease. Among patients who received high-dose chemotherapy, the relapse-free survival was 63% compared with 35% for patients who did not receive this consolidation treatment.


CONCLUSIONS
Currently available salvage chemotherapy with ifosfamide and cisplatin is predicted to cure approximately 30% of the patients who have failed first-line treatment. Whether high-dose chemotherapy with hematopoietic stem cell support after salvage VIP/VeIP could improve these modest results remains to be confirmed in a randomized study.
Farhat
F
F
Department of Medicine, Institut Gustave Roussy, Villejuif Cedex, France.
Culine
S
S
Théodore
C
C
Békradda
M
M
Terrier-Lacombe
M J
MJ
Droz
J P
JP
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005047:Etoposide / Q000008:administration & dosage; D018237:Germinoma / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008297:Male; D016879:Salvage Therapy / Q000379:methods*; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000401:mortality; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage
D014747:Vinblastine; D005047:Etoposide; D002945:Cisplatin; D007069:Ifosfamide