Risk-adapted chemotherapy of germ cell tumors with carboplatin, etoposide and bleomycin for low-risk and cisplatin, etoposide and ifosfamide for high-risk patients - A single-center study

The prognosis of germ cell tumors treated with chemotherapy depends on the presence of nonseminomatous tumor, clinical parameters based on the tumor v olume and site, as well as on the level of the tumor markers AFP, beta HCG and LDH. We report here on the results of a risk-adapted approach to the ch emotherapy of germ cell tumors. Patients with low-risk tumors, defined as s eminomatous disease and/or nonseminomatous disease with a tumor mass <10 cm , less than 20 lung metastases, no liver, bone, or CNS metastases, and leve ls of AFP <1,000 IU/ml and beta HCG <10,000 IU/I, were to receive 4 cycles of carboplatin 400 mg/m(2) i.v. day 1, etoposide 120 mg/m(2) i.v. days 1-3 and bleomycin 30 IU i.v. days 1, 8 and 15 during the first 3 cycles (CEB90) . Patients with high-risk disease were to receive 4 cycles of ifosfamide 1, 500 mg/m(2) continuous infusion on days 1-4 together with mesna 1,200 mg/m( 2) days 1-5, cisplatin 20 mg/m(2) i.v. days 1-5 and etoposide 100 mg/m(2) i .v. days 1-5 (VIP). Of the 60 patients treated with this risk-adapted appro ach, 51 had low-risk and 9 had high-risk disease. Forty-five of 51 patiens treated with CEB90 achieved complete remission (CR), 4 achieved partial rem ission with marker negativity. Four patients with CR relapsed between 4 to 8 months after the start of chemotherapy. Of the 6 patients failing CEB90, 3 were treated successfully with surgery or further chemotherapy. With a me dian follow-up of 52 months, the estimated cause-specific 3-year survival i s 93% (95% confidence interval, CI, 80-98%). Seven of 9 high-risk patients treated with VIP achieved a CR and 1 patient relapsed. All 3 patients faili ng VIP had successful salvage therapy. With a medium follow-up of 63 months all patients remain alive and free of disease. Forty-six patients receivin g CEB90 were retrospectively classified to be in the good prognosis group a ccording to the international germ cell consensus classification. Their est imated 3-year survival was 95% (CI 81-99%). We thus confirm that CEB90 is a well-tolerated outpatient regimen with good results in good prognosis germ cell tumors. Bleomycin at a cumulative dose of 270 U might contribute subs tantially to the inferior effect of carboplatin as compared to cisplatin. H owever, in view of the results of randomized studies favoring cisplatin ove r carboplatin, it is not recommended to use this regimen outside a clinical trial. Copyright (C) 2000 S. Karger AG, Basel.