EVALUATION OF LONG-TERM RESULTS OF A MODIFIED VAB-6 CHEMOTHERAPY REGIMEN IN A COHORT OF GOOD-RISK METASTATIC NON SEMINOMATOUS GERM-CELL TUMORS

From 1984 to 1988, we conducted at Institut Gustave-Roussy a phase II trial with a modified VAB-6 (mVAB-6) chemotherapy regimen in 50 patien ts with good prognosis metastatic nan seminomatous germ-cell tumors, i ncluding 27 patients (54%) with retroperitoneal lymph nodes only. The mVAB-6 combination consisted of vinblastine 4 mg/m(2)/day nt a, of act inomycin D 1 mg/m(2)/day nt dl, of cyclophosphamide 600 mg/m(2)/day at dl, of cisplatin 120 mg/m(2)/day at dl and of bleomycin 20 mg/day fro m dl to d3. Four cycles of mVAB-6 were delivered every 4 weeks. A comp lete response was observed in 46 patients (92%). The other 4 patients achieved a partial response with normal serum tumor markers. Forty-two patients (84%) remain continuously free of disease. Eight relapses su bsequently occurred 3 to 60 months after the end of treatment. Overall 45 patients (90%) remain free of disease after a median follow-up of 8 years. The long-term clinical toxicity Ic,as minimal Three patients developed secondary tumors: 2 contralateral non seminomatous germ-cell tumors and 1 pancreatic adenocarcinoma. We conclude that the mVAB-6 r egimen yielded excellent results and minimal long-term toxicity in thi s group of patients with very good-risk metastatic tumors.