Adjuvant Vinblastine, Actinomycin D, Bleomycin, Cyclophosphamide and Cis-Platinum Chemotherapy Regimen with and without Maintenance in Patients with Resected stage IIB Testis Cancer

Abstract

A total of 42 patients with stage IIB nonseminomatous germ cell tumors of the testis after orchiectomy and retroperitoneal lymph node dissection received adjuvant chemotherapy with the modified vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum regimen. Of the patients 29 had N2B and 13 had N3 nodal categories. Adjuvant vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum chemotherapy was given with maintenance in the first 24 patients and without maintenance (2 mo. of chemotherapy) in the subsequent 18. Chemotherapy with maintenance was given for 1 yr and began with 2 inductions 3 to 4 wk apart: 600 mg/m2 i.v. cyclophosphamide, 30 mg i.v. bleomycin, 1 mg/m2 i.v. actinomycin D and 4 mg/m2 i.v. vinblastine on day 1, 20 mg/m2 bleomycin daily by continuous 24-h induction on days 1-3 and 120 mg/m2 i.v. cis-platinum with mannitol-induced diuresis on day 4. Maintenance with 6 mg/m2 i.v. vinblastine and 1 mg/m2 i.v. actinomycin D every 3 wk was initiated 3 wk after the second induction for the remainder of the year. Adjuvant vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum chemotherapy without maintenance was given for 2 mo. and used 3 inductions identical to those described previously. Complete remission has been maintained in 41 of 42 patients: all 24 who received maintenance chemotherapy and 17 of 18 who did not. One patient had a relapse with sarcoma and 6 required broad-spectrum antibiotics for fever during myelosuppression. A temporary increase in the serum creatinine of more than 2 mg per cent occurred in 1 patient. Chronic renal failure or pulmonary fibrosis was not seen. Vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum chemotherapy is effective in the prevention of recurrences in patients with resected stage IIB disease, and suggest that adjuvant chemotherapy is equally effective with or without maintenance.