Successful treatment of good‐risk disseminated testicular cancer with cisplatin, bleomycin, and reduced‐dose vinblastine

Abstract

Cisplatin, vinblastine and bleomycin (PVB) is very effective therapy in disseminated testicular cancer, but toxicity is severe. A further reduction of vinblastine might reduce the acute toxicity of PVB without compromising the response rate in good‐risk patients. Starting in March 1982, 42 consecutive patients with minimal or intermediate advanced disease (Iymph node metastases <10 cm, lung nodules <5 cm) began a 0.2‐mg/kg vinblastine PVB regimen, provided that serum alpha‐fetoprotein (AFP) levels were not greater than 1000 ng/ml and human chorionic gonadatropin (HCG) values were not greater than 50,000 mIU/ml. Only 9 patients (21.4%) had leukocyte counts <1000/mm3, 6 (14%) had infections, but none had documented sepsis. Gastrointestinal and neuromuscular toxicities were mild. Of the 42 patients, 41 (97.6%) entered complete remission (CR), 8 with surgery. After a median follow‐up period of 26 months (range, 19–40 months), 35 patients (83.3%) are continuously disease‐free. Of the 6 patients with AFP levels> 400 ng/ml and/or HCG values> 1000 mIU/ml, only 2 (33.3%) entered continuous CR, versus 33 (91.6%) of the 36 patients with normal or less elevated markers (P <0.01). PVB with a 0.2‐mg/kg vinblastine dosage is very effective and well‐tolerated therapy in selected good‐risk patients with disseminated germinal testis cancer. Copyright © 1986 American Cancer Society