Vinblastine, Actinomycin D, Bleomycin, Cyclophosphamide and Cis-Platinum Combination Chemotherapy in Metastatic Testis Cancer—A 1-Year Program

Abstract

Vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum were given in 31 men with stage III or bulky stage II malignant germ cell tumors of the testis and no previous chemotherapy, 25 of whom were evaluable. This regimen was given for 1 year and began with 3 successive inductions at 3 to 4-week intervals: 600mg./m.2 intravenous cyclophosphamide, 4mg./m.2 intravenous vinblastine, 30mg. intravenous bleomycin and 1mg./m.2 intravenous actinomycin D on day 1, followed by continuous 24-hour infusion of 20mg./m.2 bleomycin per day on days 1 to 3 and 120mg./m.2 intravenous cis-platinum with mannitol-enhanced diuresis on day 4. Any residual disease was resected 1 month after the third induction. If the resected specimen contained malignant tissue an additional 2 inductions (total 5) were given before brief maintenance with 6mg./m.2 intravenous vinblastine and 1mg./m.2 intravenous actinomycin D every 3 weeks for the remainder of 1 year. Complete remission occurred in 23 of 25 evaluable patients (92 per cent) and 20 (80 per cent) remain free of disease with a median followup of more than 27 months. Patients with minimal metastatic deposits and those without teratoma in the testis tumor had high complete remission rates with chemotherapy alone. Patients with advanced disease and with teratoma in the primary tumor benefited more frequently from the combined approach. Myelosuppression was the major potentially serious toxic effect. Vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum were superior to prior vinblastine, actinomycin D and bleomycin programs because higher complete remission rates were achieved with shorter duration of treatment and lesser disability.