Twenty-four patients with resected Stage 11-B nonseminomatous germ cell tumors of the testis received adjuvant chemotherapy with the modified VAB-6 regimen for one year. Eighteen patients had nodal category N2B and six nodal category N3 (extranodal extension of tumor). Adjuvant VAB-6 started with two four day inductions at approximately four week intervals. Induction was cyclophosphamide 600 mg/m2 IV, vinblastine 4 mg/m2 IV, dactinomycin 1 mg/m2 IV, bleomycin 30 mg IV on day 1, then bleomycin 20 mg/m2/day by continuous 24 hour infusion for three days, and cis-platinum 120 mg/m2 IV on day 4. Maintenance was vinblastine 6 mg/m2 IV and dactinomycin 1 mg/m2 IV every three weeks. Six patients received a third induction but without bleomycin. All 24 patients remain free of disease with a median follow up of 24 months. Myelosuppression was the major toxicity. Four patients received antibiotics for fever during myelosuppression. In one patient, serum creatinine temporarily rose over 2 mg/dl after cis-platinum. VAB-6 is effective in the prevention of recurrences in resected Stage 11-B nonseminomatous germ cell tumors. However, the optimal regimen remains to be defined.
Cancer 515-8, 1983.
ITH OPTIMAL TREATMENT, the potential for C U R W of patients with nonseminomatous germ cell tumors of the testis (NSGCT) is high. Following orchiectomy and retroperitoneal lymph node dissection (RPLND), 40-50% (range, 20-809'0) of patients with Stage I1 NSGCT will relapse.'-5 Most of the recurrences are due to distant metastases, and patients with resected Stage 11-B disease are particularly at risk for relapse. In resected Stage 11-B neoplasm, effective adjuvant chemotherapy requires a regimen of proven effectiveness in Stage 111 disease: application of the VAB-3 regimen in resected Stage 11-B NSGCT was associated with no relapse among 29 patients. The VAB-3 program was given for two years, used seven drugs, consisted of two inductions 5-6 months apart, and outpatient treatments every three weeks. When the superiority of the VAB-6 over the VAB-3 regimen was shown in Stage I11 disease, adjuvant chemotherapy with a modified VAB-6 regimen for one year was employed in 24 patients with resected From the