Eighty-two patients with metastatic germ cell tumors (GCT) treated with two-drug therapy consisting of etoposide and cisplatin were evaluated for late relapse. Goodrisk GCT was defined using Memorial Sloan-Kettering Cancer Center (MSKCC) criteria. Etoposide was given a t 100 mg/mz on days 1 to 5 and cisplatin was given at 20 mg/m2 on days 1 to 5; therapy was recycled at 21 days with delays up to 7 days for a leukocyte count of less than 3000/pl or a platelet count of less than 100,000/ pl. Drug doses were not attenuated for myelosuppression. Seventy-six of 82 evaluable patients achieved a complete response (CR). Seventy-two patients had a CR to chemotherapy alone. Forty-six (56%) patients had excision of residual abnormalities: 11 had teratoma in the resected specimen, 31 had necrotic debris or fibrosis, and 4 had a CR after chemotherapy plus complete excision of residual viable GCT. Six patients had an incomplete response to chemotherapy; one of these patients had unresectable mature teratoma and remains progression-free. The median etoposide dose (+ standard deviation [SD]) was 500 mg/m2/course (+ 35 mg/ mz) and the median cisplatin dose (+ SD) was 100 mg/mz/course (* 6 mg/mz). Nine patients experienced a relapse at 6 to 17.5 months; two patients with nonseminomatous GCT were salvaged by chemotherapy and one patient with seminoma was salvaged by chemotherapy and radiation therapy. The three patients who were salvaged by additional therapy are disease-free at 59 to 63 months. Seventy-one patients (87%) remain disease-free with a median follow-up time of 63 months (range, 33 to 92 months). No relapses have occurred beyond 17.5 months. Etoposide and cisplatin therapy at these doses and schedule results in durable CR without late relapse. Cancer 6728-32,1991.
HE TREATMENT of metastatic germ cell tumors T (GCT) with modern chemotherapy results in the cure of approximately 70% to 80% of patients.' Clinical trials in patients with good-risk disease (ie., patients with a high probability of cure) focus on decreasing the toxicity of chemotherapy. These efforts include deleting chemotherapeutic agents with well-known toxicities including intestinal ileus, Raynaud's phenomenon, pulmonary fibrosis, emesis: and nephrotoxicity,2-6 or decreasing the duration of the rap^.^