VINBLASTINE PLUS IFOSFAMIDE PLUS CISPLATIN AS INITIAL SALVAGE THERAPYIN RECURRENT GERM-CELL TUMOR

Purpose: This study was designed to assess the effectiveness of vinbla stine, ifosfamide, and cisplatin (VelP) as second-line therapy in pati ents with recurrent germ cell tumors with previous treatment with cisp latin plus etoposide, usually in combination with bleomycin. Patients and Methods: From July 1984 through December 1989, 135 patients with p rogressive, disseminated germ cell tumors after cisplatin-etoposide-ba sed combination therapy induction chemotherapy were treated with VelP. Patients who progressed within 3 weeks of previous cisplatin therapy were not eligible. Progression was documented by biopsy or increasing serum markers. No exclusion was made on the basis of metastatic site o r performance status. The dosages were vinblastine 0.11 mg/kg/d (days i and 2), ifosfamide 1.2 gm/m(2)/d (days 1 through 5), and cisplatin 2 0 mg/m(2)/d (days 1 through 5), with courses repeated every 21 days fo r four cycles. Results: Sixty-seven(49.6%) patients achieved a disease -free status after chemotherapy with or without surgical resection of residual carcinoma or teratoma, Overall, 42 (32%) patients are alive a nd 32 (23.7%) are continuously free of disease. None of the 32 patient s with nonseminomatous extragonadal tumors are disease-free compared w ith 30 of 100 patients with gonadal primaries. Two of three extragonad al seminomas are continuously disease-free, Conclusion: VelP is capabl e of producing durable complete remissions in patients with disseminat ed germ cell cancer who relapse after cisplatin-etoposide-based induct ion therapy Long-term disease-free survival is not seen in those patie nts with extragonadal nonseminomatous germ cell tumors. (C) 1998 by Am erican Society of Clinical Oncology.