TREATMENT OF ADVANCED SEMINOMA WITH CYCLOPHOSPHAMIDE, VINCRISTINE ANDCARBOPLATIN ON AN OUTPATIENT BASIS

This study describes the efficacy and toxicity of a combination regime n consisting of cyclophosphamide, vincristine (oncovin) and carboplati n (COC) for advanced seminoma on an outpatient basis. Twenty-seven pat ients (mean age 43 years, range 28-63 years) were classified as stage IIC (n = 5), stage IID (n = 12), stage III (n = 9) or stage IV (n = 1) . Six had been treated with prior radiotherapy; elevated B-HCG and ele vated LDH serum levels were observed in 15 and 25 patients respectivel y. Patients were treated with four cycles of 750 mg m(-2) cyclophospha mide intravenously (i.v.), 1.4 mg m(-2) vincristine i.v. (maximum 2 mg ) and carboplatin adjusted to creatinine clearance. Cycles were given at 3 week intervals. The median dose of carboplatin administered was 4 00 mg m(-2) (range 300-450 mg m(-2)). Six patients [22%; 95% confidenc e interval (CI), 6-38%] achieved a complete response (CR), 19 (70%; 95 % CI, 51-88%) a partial response and two (8%; 95% CI, 0-18%) showed on ly a response in tumour markers but not a reduction of retroperitoneal mass (NR). Post-chemotherapeutic masses were not removed surgically o r irradiated. After a median Follow-up of 26 months (range 5-69 months ), two patients have died, one from cardiac arrest 2 years after achie ving CR, the other with relapsed seminoma 5 months after therapy. None of the other patients relapsed. Main toxicity was haematological, wit h 22 patients (81%) experiencing thrombocytopenia WHO grade III/IV and 27 (100%) leucocytopenia WHO grade III/IV, requiring dose reduction i n five patients. Seven patients experienced granulocytopenic fever. No n-haematological toxicity was rare. Peripheral neuropathy grade I was observed in four patients and grade III in one. Haemorrhagic cystitis occurred once. In conclusion, despite considerable haematological toxi city, COC is feasible on an outpatient basis, even after prior radioth erapy, and is an effective regimen for advanced seminoma with only 1/2 7 treatment failures after a median follow-up of 26 months.