Vinblastine, Actinomycin D, Bleomycin, Cyclophosphamide and Cis-Platinum for Advanced Germ Cell Testis Tumors: Brazilian Experience

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Abstract
Disseminated germ cell testicular cancer proved to be highly sensitive to platinum-containing chemotherapy regimens. Data is presented concerning the treatment of advanced seminoma and nonseminomatous tumors in a developing country. Thirty patients with advanced germ cell testis tumors with 3 or 4 cycles of vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum. Surgical resection of residual masses was done 30 days after completion of chemotherapy in 18 patients. The histology of the primary tumor was seminoma in 13 patients and nonseminomatous tumors in 17. Toxicity was mild and no treatment-related deaths occurred. All 13 patients (100%) with seminoma and 12 of 17 patients (71%) with nonseminomatous tumors had a complete response to chemotherapy and 1 of 17 patients was free of disease after a debulking operation and additional chemotherapy. A total of 3 patients with seminoma and 2 with nonseminomatous tumors had recurrences 5-8 mo. after an initial complete response and received additional chemotherapy (VP-16% regimen) with or without radiotherapy. Complete clinical response was achieved in 4 of 5 patients. Median followup was 24 mo. (range 8-38 mo.) in the 13 patients with seminoma and 28 mo.(range 9-58 mo.) in thosewith nonseminomatous tumors and 13 (100%) and 12 (71%), respectively, are alive without evidence of disease. These data suggest that the protocol of vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum is highly effective and minimally toxic in the treatment of disseminated germ cell testicular cancer, inducing an 83% long-lasting clinical remission. Seminomas seem to be equally or even more sensitive than nonseminomatous tumors to this platinum-containing chemotherapy regimen. Recurrence after initial complete response can be treated successfully with regimens containing VP-16.