Forty-two patients with advanced testis carcinoma without previous chemotherapy were treated with VAB-4, and 41 were evaluable. The program consisted of three in-hospital inductions 16 weeks apart, and outpatient treatments every three weeks. Of the patients, 80% achieved complete remissions (CR). Chemotherapy alone induced CR in 61%, partial remissions (PR), in 24% and minor response (MR), in 15%. An additional 20% of patients (six PRs and 2 MRs) achieved CR following resection of residual tumor deposits. With a median follow-up of 27 months, the median duration of CR has not been reached. Of those achieving CR to chemotherapy alone, 12% had relapses. Bulk and extent of metastatic disease, histology of primary tumor, and tumor markers a t the beginning of therapy influenced the frequency of CR. Of those with minimal disease, 90% achieved CR. The CR rate was 67% for those with advanced thoracic disease and 29% for those with advanced abdominal disease. Patients who had embryonal carcinoma and those who had no elevation of alpha-fetoprotein had a higher frequency of CRs. Myelosuppression with a leukocyte count drop < 1000/mm3 occurred in three patients, and no patient had chronic renal failure or pulmonary fibrosis. One patient died from sepsis while in complete remission.
Cancer 47:833-839, 1981.
H E G O A L OF treatment of metastatic germ cell
T tumors is 100% cure with minimal toxicity, and production of complete remission is an essential first step. Between 1972 and 1976 at Memorial Sloan-Kettering Cancer Center, three VAB protocols, incorporating successively larger numbers of effective drugs, increased complete remissions (CR) from 15% to 60% with relatively low serious toxicity.'-3 However, all patients who achieved CR were not cured. Relapse from CR decreased from 56% with VAB-2 to 3 1% with VAB-3.:' Induction was apparently the most effective part of the treatment in reducing metastatic deposits in the VAB-3 regimen, but progression of disease occurred in some patients before the reinduction at 5-6 months. Therefore, in the next protocol, VAB-4, reinductions were scheduled at 16-week intervals; the number of inductions was increased to three. During