Treatment of poor prognosis nonseminomatous testicular cancer with a “high‐dose” platinum combination chemotherapy regimen

Abstract

A new intensive four drug combination chemotherapy regimen, termed PVeBV, consisting of cis‐platinum, vinblastine, bleomycin, and VP‐16, was administered to six previously untreated patients with poor prognosis advanced nonseminomatous testicular cancer and to four patients who had relapsed on primary platinum based regimens. The cis‐platinum was administered in 250 ml of 3% saline at twice the dose (40 mg/m2 IV days 1–5 every three weeks) used in other treatment schedules. All six previously untreated patients achieved a complete remission. Four achieved a complete remission with three cycles of PVeBV while the other two patients achieved a complete remission with an additional cycle of cisplatinum and VP‐16 at 200 mg/m2 IV × five followed by autologous bone marrow infusion. All four relapsed patients responded to PVeBV (two complete remissions and two partial remissions). There were no deaths associated with PVeBV therapy; however, myelosuppression was severe. There has been no renal toxicity (other than hypomagnesemia) observed with 35 cycles of high‐dose platinum therapy in previously untreated patients. These results indicate that PVeBV is a promising chemotherapy regimen for the treatment of poor prognosis testicular cancer patients. Furthermore, it appears that cis‐platinum can be administered at higher doses than previously used without an increase in renal toxicity if administered in hypertonic saline. The high‐dose cis‐platinum schedule, as used in PVeBV, warrants evaluation in other tumors which respond to standard‐dose platinum therapy. Copyright © 1983 American Cancer Society