CISPLATIN AND IFOSFAMIDE WITH EITHER VINBLASTINE OR ETOPOSIDE AS SALVAGE THERAPY FOR REFRACTORY OR RELAPSING GERM-CELL TUMOR PATIENTS - THEINSTITUT-GUSTAVE-ROUSSY EXPERIENCE

BACKGROUND. Approximately 30% of patients with metastatic germ cell tu mors require salvage chemotherapy for recurrent or refractory disease after first-line treatment. The optimal salvage chemotherapy regimen r emains to be determined.METHODS. Fifty-four patients with metastatic g erm cell tumors who failed to be cured with first-line therapy, were t reated with a salvage VIP/VeIP regimen including cisplatin (20 mg/m(2) /d d1 to d5), ifosfamide (1.2 gm/m(2)/d d1 to d5), and either etoposid e (75 mg/m(2)/d d1 to d5) or vinblastine (0.11 mg/kg/d d1 and d2) for 5 consecutive days every 3 weeks. RESULTS. A complete remission was ob served in 24 patients (44%) at completion of VIP/VeIP chemotherapy. In 17 patients (31%), complete remission was reached with chemotherapy a lone, whereas four (7%) were rendered tumor-free by resection of the r esidual inactive tumor. Three patients (6%) became tumor-free by resec tion of the residual carcinoma. Ten other patients (19%) achieved a pa rtial response, with normalization of serum tumor markers. Eleven of t hose thirty-four patients additionally received high-dose chemotherapy with hematopoietic stem cell support as consolidation treatment. Twen ty patients (37%) were judged to be treatment failures because of eith er incomplete response (3 patients) or progression of disease (17). My elotoxicity was severe, but no toxicity deaths were noted. After a med ian follow-up of 30 months, 23 patients (43%) are alive, 16 of whom (3 0%) are without evidence of progression of disease. Among patients who received high-dose chemotherapy, the relapse-free survival was 63% co mpared with 35% for patients who did not receive this consolidation tr eatment. CONCLUSIONS. Currently available salvage chemotherapy with if osfamide and cisplatin is predicted to cure approximately 30% of the p atients who have failed first-line treatment. Whether high-dose chemot herapy with hematopoietic stem cell support after salvage VIP/VeIP cou ld improve these modest results remains to be confirmed in a randomize d study. (C) 1996 American Cancer Society.