A new intensive four drug combination chemotherapy regimen, termed PVeBV, consisting of cis-plathum, vinblastine, bleomycin, and VP-16, was administered to six previously untreated patients with poor prognosis advanced nonseminomatous testicular cancer and to four patients who had relapsed on primary platinum based regimens. The cis-platinum was administered in 250 ml of 3% saline at twice the dose (40 mg/m2 IV days 1-5 every three weeks) used in other treatment schedules. All six previously untreated patients achieved a complete remission. Four achieved a complete remission with three cycles of PVeBV while the other two patients achieved a complete remission with an additional cycle of cisplatinum and VP-16 at 200 mg/m2 IV X five followed by autologous bone marrow infusion. All four relapsed patients responded to PVeBV (two complete remissions and two partial remissions). There were no deaths associated with PVeBV therapy; however, myelosuppression was severe. There has been no renal toxicity (other than hypomagnesemia) observed with 35 cycles of highdose platinum therapy in previously untreated patients. These results indicate that PVeBV is a promising chemotherapy regimen for the treatment of poor prognosis testicular cancer patients. Furthermore, it appears that cis-platinum can be administered at higher doses than previously used without an increase in renal toxicity if administered in hypertonic saline. The highdose cis-platinum schedule, as used in PVeBV, warrants evaluation in other tumors which respond to standarddose platinum therapy.
Cancer 51:1803-1807, 1983.
IS-PLATINUM based combination chemotherapy
C regimens have resulted in dramatic improvements in the treatment of patients with disseminated nonseminomatous testicular cancer. Complete response rates between 60-8070 have been reported for patients with advanced disease and the vast majority of these patients are cured of their disease as the relapse rates are less than 15%. However, there is a clinically definable subset of patients with testicular cancer in whom current combination chemotherapy regimens have been markedly less effective. Poor prognostic features include: bulky disease (palpable abdominal mass or intrathoracic metastases greater than 2.0 cm diameter), the presence of an extragonadal primary, visceral metastases, or marked elevations in serum levels of human chorionic gonadotropin (HCG) or alpha-fetoprotein (AFP). '-" In the largest single series of patients treated with a platinum