title: The limited efficacy of methotrexate, actinomycin D and cisplatin (MAP) for patients with advanced testicular cancer.
abstract: BACKGROUND
  Combination chemotherapy of methotrexate, actinomycin D and cisplatin (MAP) is reported to be effective against gestational choriocarcinoma.
  
  
  METHODS
  Eight patients with metastatic testicular cancer who had elevated beta-hCG were treated with MAP. They included three refractory cases and two relapsed cases. An additional three patients received MAP as part of the induction therapy. The MAP therapy consisted of methotrexate (10 mg/m2) on days 1-5, actinomycin D (0.01 mg/kg) on days 1-5 and cisplatin (70 mg/m2) on day 1.
  
  
  RESULTS
  In all three refractory patients, MAP failed to achieve tumor marker normalization. However, the elevated tumor markers normalized after MAP in the two cases of relapse. Of these two, one patient relapsed again 7 months after MAP and was subsequently salvaged with high-dose chemotherapy. The other patient relapsed and died of the disease 30 months after receiving MAP. Of the three patients who received MAP as part of the induction chemotherapy, one with pure choriocarcinoma achieved tumor marker normalization after MAP and is still alive without disease progression. In the other two patients, MAP failed to achieve marker normalization and the patients received high-dose chemotherapy. The toxicities were mainly bone marrow suppression and mucositis, which were almost acceptable.
  
  
  CONCLUSIONS
  The results demonstrated the limited efficacy of MAP as salvage therapy. In addition, the efficacy of MAP as part of induction chemotherapy was negligible. However, there might be some role for MAP as a salvage therapy for patients with pure choriocarcinoma.
authors.affiliation: Department of Urology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan. kontama@v004.vaio.ne.jp
authors.forename: Jun
authors.initials: J
authors.lastname: Miyazaki
authors.forename: Koji
authors.initials: K
authors.lastname: Kawai
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hayashi
authors.forename: Mizuki
authors.initials: M
authors.lastname: Onozawa
authors.forename: Sadamu
authors.initials: S
authors.lastname: Tsukamoto
authors.forename: Naoto
authors.initials: N
authors.lastname: Miyanaga
authors.forename: Shiro
authors.initials: S
authors.lastname: Hinotsu
authors.forename: Toru
authors.initials: T
authors.lastname: Shimazui
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Akaza
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002822:Choriocarcinoma / Q000188:drug therapy*; D002945:Cisplatin / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D006801:Humans; D007970:Leukopenia / Q000139:chemically induced; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D016879:Salvage Therapy; D013736:Testicular Neoplasms / Q000188:drug therapy*; D013921:Thrombocytopenia / Q000139:chemically induced; D016896:Treatment Outcome
chemical_list: D003609:Dactinomycin; D002945:Cisplatin; D008727:Methotrexate