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Cisplatin and ifosfamide with either vinblastine or etoposide as salvage therapy for refractory or relapsing germ cell tumor patients: The Institut Gustave Roussy experience
Author(s) -
Farhat Fadi,
Culine Stéphane,
Théodore Christine,
Békradda Mohamed,
TerrierLacombe MarieJosée,
Droz JeanPierre
Publication year - 1996
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(19960315)77:6<1193::aid-cncr28>3.0.co;2-w
Subject(s) - medicine , ifosfamide , etoposide , vinblastine , chemotherapy , salvage therapy , germ cell tumors , regimen , surgery , progressive disease , chemotherapy regimen , oncology , gastroenterology
BACKGROUND Approximately 30% of patients with metastatic germ cell tumors require salvage chemotherapy for recurrent or refractory disease after first‐line treatment. The optimal salvage chemotherapy regimen remains to be determined. METHODS Fifty‐four patients with metastatic germ cell tumors who failed to be cured with first‐line therapy, were treated with a salvage VIP/VeIP regimen including cisplatin (20 mg/m 2 /d d1 to d5), ifosfamide (1.2 gm/m 2 /d d1 to d5), and either etoposide (75 mg/m 2 /d d1 to d5) or vinblastine (0.11 mg/kg/d d1 and d2) for 5 consecutive days every 3 weeks. RESULTS A complete remission was observed in 24 patients (44%) at completion of VIP/VeIP chemotherapy. In 17 patients (31%), complete remission was reached with chemotherapy alone, whereas four (7%) were rendered tumor‐free by resection of the residual inactive tumor. Three patients (6%) became tumor‐free by resection of the residual carcinoma. Ten other patients (19%) achieved a partial response, with normalization of serum tumor markers. Eleven of those thirty‐four patients additionally received high‐dose chemotherapy with hematopoietic stem cell support as consolidation treatment. Twenty patients (37%) were judged to be treatment failures because of either incomplete response (3 patients) or progression of disease (17). Myelotoxicity was severe, but no toxicity deaths were noted. After a median follow‐up of 30 months, 23 patients (43%) are alive, 16 of whom (30%) are without evidence of progression of disease. Among patients who received high‐dose chemotherapy, the relapse‐free survival was 63% compared with 35% for patients who did not receive this consolidation treatment. CONCLUSIONS Currently available salvage chemotherapy with ifosfamide and cisplatin is predicted to cure approximately 30% of the patients who have failed first‐line treatment. Whether high‐dose chemotherapy with hematopoietic stem cell support after salvage VIP/VeIP could improve these modest results remains to be confirmed in a randomized study. Cancer 1996;77:1193‐7.