Possible benefit of doxorubicin treatment in patients with refractory germ cell cancer

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Abstract
Forty patients with germ cell cancer (GCC) refractory to vinblastine, cisplatin, and bleomycin therapy were treated with etoposide (E), cisplatin ± bleomycin ± doxorubicin and were evaluated retrospectively to determine response to treatment. Thirty cancers were primary testicular and ten extragonadal in origin. Fifty-five percent (22/40 patients) of the group responded to therapy. Eight of 40 (20%) patients had complete responses (CR) and 14 of 40 (35%) had partial responses (PR). Seven of 30 (23%) patients with a testes primary had a CR in contrast to 1 of 10 patients with extragonadal origin cancer. Six of eight patients (75%) having a CR received doxorubicin in combination, while only 2 of 18 (11%) patients having no response were treated with a doxorubicin-combining regimen. Of the entire group, 12 of 14 patients (86%) treated with doxorubicin for the first time responded to therapy compared to 10 to 26 patients (38.5%) not receiving doxorubicin (P = 0.009 Fisher's exact test). Myelosuppression was more frequent in patients treated with doxorubicin (87%) than in those treated without doxorubicin (70%). No increased freqency of hospitalization was required and no treatment-related fatalities occurred. Salvage therapy of patients with GCC appears to be improved when doxorubicin is added to etoposide, cisplatin, and bleomycin.