Dose-response and dose-survival advantage for high versus low-dose cisplatin combined with vinblastine and bleomycin in disseminated testicular cancer a southwest oncology group study

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Abstract
One‐hundred fourteen patients with advanced testicular cancer were randomized to treatment consisting of either high‐dose (120 mg/m2, monthly) or low‐dose (15 mg/m2, daily X 5 monthly) cisplatin, both combined with vinblastine and bleomycin. There were 60 (53%) complete remissions and 42 partial remissions for an overall response rate of 90%. An additional 11 patients, 4 with carcinoma and 7 with mature teratoma, following surgical cytoreduction, were rendered free of disease. There was a significantly higher complete response rate for high dose induction chemotherapy, 63%, when compared with low dose, 43% (P = 0.03). A survival advantage was also observed for patients receiving high‐dose therapy (P = 0.009). For the subgroup of patients with maximal disease and embryonal ± teratoma ± seminoma histology there was a clear advantage in favor of high‐dose over low‐dose therapy both in complete response rate and survival (P = 0.03). There have been only four relapses, all occurring within 1 year of study entry. While there has been a higher frequency of leukopenia, renal, neuromuscular, and mucosal toxicity with high‐dose therapy, thus far no irreversable toxicity leading to functional impairment has been seen. The authors have demonstrated a clear‐cut relationship for dose of therapy, not only with response and survival, but with the increased potential for cure as well. Cancer 53:1029‐1035, 1984.