Sequential intermediate high-dose therapy with etoposide, ifosfamide and cisplatin for patients with germ cell tumors

Intermediate high dose VIP (etoposide, ifosfamide, cisplatin) achieved comp arable efficacy and improved tolerance in comparison with high-dose chemoth erapy plus PBSC in poor risk germ cell tumors. The aim of this study was to confirm the effectivity and tolerance of this regimen in clinical practice . Twenty-five consecutive patients, 9 previously untreated with poor prognosi s and 16 relapsed, were treated with 1.6 VIP or 1.9 VIP+PBSC. A relative do se intensity of 1.6 VIP was used in 14 patients and 11 patients received th e intensity of 1.9 VIP. Clinical response was achieved in 56% of patients. Fifty-eight percent of p atients have survived more than I year and 44% more than 2 years. No signif icant difference was noted between previously treated and untreated patient s, as well as between the patients on 1.6 VIP and 1.9 VIP, with the excepti on of improved 1-year survival of patients on 1.9 VIP. One of four cisplati n-refractory patients achieved durable partial remission with a normal leve l of tumor markers. Serious nonhematological toxicity was rare. Myelotoxici ty of 1.9 VIP was less serious in comparison with 1.6 VIP regimen, but the difference was not significant. Sequential intermediate high-dose therapy is an effective and tolerable reg imen for patients with poor risk germ cell tumor as well as for relapsed pa tients.