Chemotherapy of Disseminated Non-Seminomatous Testicular Cancer and Metastatic Seminoma with Ifosfamide/Mesna1

Abstract

Summary2Although the prognosis for metastatic non-seminomatous testicular cancer has been dramatically improved during the past decades due to the development of combination chemotherapy, the search for new chemotherapy alternatives for salvage therapy has become one of the major challenges.Since 1977 we have investigated the cytotoxic efficacy of ifosfamide alone (60 mg/kg B.W./d i.v., days 1–5, q 21–28 days) or in combination with etoposide (40 mg/kg B.W./d ifosfamide i.v., days 1–5, 120 mg/m2 B.S.A./d etoposide i.v., days 1, 3, and 5, q 21–28 days) in 150 patients with metastatic non-seminomatous testicular cancer resistant to vinblastine, bleomycin, adriamycin, and cis-platinum.Response rates — including minor responses — were 33% for ifosfamide (CR + PR 19%) and 46% for ifosfamide/etoposide (CR + PR 30%), respectively. The incidence of urinary tract complications, the dose-limiting toxic side-effect of ifosfamide, could be effectively reduced from 27% to 4% by co-administration of mesna (12 mg/kg B.W. i.v., 0, 4, and 8 h after ifosfamide).Ifosfamide proved to be one of the most potent cytotoxic drugs in the primary treatment of metastatic seminomas as well. Complete responses could be achieved in 16/17 patients (94%) by ifosfamide, ifosfamide/etoposide or ifosfamide/cis-platinum (40 mg/kg B.W./d ifosfamide i.v., days 1–5, 20 mg/m2 B.S.A./d cis-platinum i.v., days 1–5, q 21–28 days). Presently, all complete responders have no evidence of disease at a median follow-up of 28 months.In conclusion, ifosfamide/mesna — one of the most active cytotoxic agents in metastatic testicular cancer — may not only be included in effective combination chemotherapy regimens for salvage therapy but also in first-line treatment of this malignant disease.