Vinblastine, Actinomycin D, Bleomycin, Cyclophosphamide and Cis-Platinum Combination Chemotherapy in Metastatic Testis Cancer—A 1-Year Program

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Abstract
Vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum were given in 31 men with stage III or bulky stage II malignant germ cell tumors of the testis and no previous chemotherapy, 25 of whom were evaluable. This regimen was given for 1 yr and began with 3 successive inductions at 3-4 wk intervals as follows: 600 mg/m2 i.v. cyclophosphamide, 4 mg/m2 i.v. vinblastine, 30 mg i.v. bleomycin and 1 mg/m2 i.v. actinomycin D on day 1, followed by continuous 24-h infusion of 20 mg/m2 bleomycin per day on days 1-3 and 120 mg/m2 i.v. cis-platinum with mannitol-enhanced diuresis on day 4. Any residual disease was resected 1 mo. after the 3rd induction. If the resected specimen contained malignant tissue an additional 2 inductions (total 5) were given before brief maintenance with 6 mg/m2 i.v. vinblastine and 1 mg/m2 i.v. actinomycin D every 3 wk for the remainder of 1 yr. Complete remission occurred in 23 of 25 evaluable patients (92%); 20 (80%) remain free of disease with a median follow-up of > 27 mo. Patients with minimal metastatic deposits and those without teratoma in the testis tumor had high complete remission rates with chemotherapy alone. Patients with advanced disease and with teratoma in the primary tumor benefited more frequently from the combined approach. Myelosuppression was the major potentially serious toxic effect. Vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum were superior to prior vinblastine, actinomycin D and bleomycin programs because higher complete remission rates were achieved with shorter duration of treatment and lesser disability.