Sequentiell-alternierende Chemotherapie nicht-seminomatöser Hodentumoren mit Adriamycin/Cisplatin und Bleomycin/Vinblastin

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Abstract
The value of sequential alternating chemotherapy was analyzed retrospectively in 180 patients with disseminated, non-seminomatous testicular cancer. Response rates of adriamycin/cisplatin - (combination A) and bleomycin vinblastine (combination B) - combination chemotherapy were evaluated separately with respect to tumor histology and tumor stages. Tumor response was achieved in 151 of 180 patients (84%) who were evaluable for adriamycin/cisplatin chemotherapy. Out of those, 91 of 117 patients (78%) pretreated with combination B and 60 of 63 patients (95%) without prior chemotherapy responded. Irrespective of pretreatment tumor response was observed in 131 of 157 patients (84%) evaluable for treatment with bleomycin/vinblastine. Resistance to combination A was 2.5 fold higher in embryonal carcinomas (class II of Dixon and Moore) than in choriocarcinomas (class V). Bleomycin/vinblastine-therapy failed more frequently in choriocarcinomas as compared to other histological categories (22% vs. 14%). This report also includes an analysis of treatment failures in different tumor stages. Both regimens were more frequently ineffective in tumor stages with a large tumor burden (stages II C and IV D). Patterns of cross-resistance were evaluated for both regimens. Response to adriamycin/cisplatin occurred in 18/26 patients (69%), when combination B had failed, and response to bleomycin/vinblastine was achieved in 14/24 patients (58%) when adriamycin/cisplatin had failed. In patients not responding to either regimen the treatment failure was already recognized after the first chemotherapeutic course in 93% of these cases.

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