The role of ifosfamide plus cisplatin‐based chemotherapy as salvage therapy for patients with refractory germ cell tumors

Abstract

A prospective study of four cycles of etoposide with ifosfamide and cisplatin (VIP) chemotherapy was conducted in 42 germ cell tumor (GCT) patients who were refractory to cisplatin with etoposide/vinblastine‐based therapy. Forty patients were evaluable for response. Ten patients (25%) had a complete response: seven to chemotherapy alone and an additional three patients after surgical resection of viable GCT. With a median follow‐up of 15 months, four complete responders relapsed, and six patients (15%) remain in remission. Hematologic and nephrotoxicity were moderately severe. Durable complete responses with VIP as second salvage were achieved and suggests that ifosfamide adds efficacy to standard first‐salvage therapy. the observed nephrotoxicity and myelotoxicity are considerations in the design of ifosfamide‐cisplatin‐based regimens. Hematopoietic growth factors may be useful in ameliorating myelotoxicity. the early use of ifosfamide‐based chemotherapy may reduce the nephrotoxicity exacerbated by prior cisplatin. A trial of VIP as first salvage after a relapse from a complete response to platinum‐based induction therapy is warranted. the modest proportion of patients who achieve a durable remission to VIP as second salvage emphasizes the need for more efficacious salvage therapy for patients who do not achieve a durable complete response. Copyright © 1990 American Cancer Society