Sixty percent salvage rate for germ-cell tumours using sequential m-BOP, surgery and ifosfamide-based chemotherapy

Background: In germ-cell tumours (GCT), there is continuing controversy ove r the relative merits of dose dense therapy (increased frequency over a giv en time) versus vertical intensification (increased dose per fraction). The value of using a cisplatin-based dose dense approach in the salvage settin g has not been documented and in addition the role of methotrexate remains uncertain. This paper reviews results from our investigations of these issu es. Patients and methods: Between 1987 and 1996, 65 patients with relapsing or refractory germ-cell tumour received weekly m-BOP (methotrexate, bleomycin, vincristine and cisplatin) as salvage therapy. Residual masses were excise d if possible and patients progressing after this received cisplatin and if osfamide based chemotherapy with or without high dose chemotherapy (HDCT) c onsolidation. Results: With a median follow-up of 33 months, 34% are progression free fol lowing m-BOP, 11% who had surgery for residual masses which showed viable c ancers are progression free. A further 15% who progressed following m-BOP w ith or without surgery were rendered progression free by third-line therapy . Conclusions: The use of m-BOP as second line therapy with deferment of cisp latin and ifosfamide based treatment to third line therapy with consolidati on of third line responses with HDCT, leads to an overall progression-free survival of 60%. It does not appear that M-BOP prejudiced the response to t hird line therapy suggesting a lack of cross resistance. The potentially lo wer risk of leukaemia and infertility from m-BOP requires further evaluatio n.