VAB-3 combination chemotherapy of metastatic testicular cancer

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Abstract
The initial response and long-term follow-up of 74 evaluable patients who received combination chemotherapy for metastatic nonseminomatous testicular cancer are reported. Patients were treated with a protocol (VAB-3) including vinblastine, actinomycin-D, bleomycin, and cis-dichlorodiammine platinum (DDP). VAB-3 alone caused complete remission (CR) in 54% (40/74) and partial remission (PR) in 26% (19/74). Five patients with less than CR to chemotherapy achieved CR following surgical excision of residual mature teratoma after starting VAB-3 protocol, resulting in an overall CR rate of 61% (45/74). With a minimum follow-up of 24+ months, and a median follow-up of 35+ months for those still living, 45% (33/74) of the patients are living free of evidence of disease, 4% (3/74) are living with disease, and 51% (38/74) are dead. Response to VAB-3 protocol was examined with respect to performance status, histology, prior therapy, extent of disease, tumor markers, and duration of disease from diagnosis. No one died because of toxicity of VAB-3, and life-threatening toxicity was uncommon. Long survival is significantly associated (P < 0.001) with achievement of CR. The treatment goal for metastatic testicular cancer is cure. The achievement of CR, using aggressive combination chemotherapy and surgery, is essential in reaching this goal.