Mardiak J, Fuchsberger P, Lakota J, Sálek T, Sycová-Milá Z, Drahokoupilová M, Baláz M, Koza I
Department of Medicine, National Cancer Institute, Bratislava, Slovak Republic.
Neoplasma. 2000;47(4):239-43.
Intermediate high dose VIP (etoposide, ifosfamide, cisplatin) achieved comparable efficacy and improved tolerance in comparison with high-dose chemotherapy plus PBSC in poor risk germ cell tumors. The aim of this study was to confirm the effectivity and tolerance of this regimen in clinical practice. Twenty-five consecutive patients, 9 previously untreated with poor prognosis and 16 relapsed, were treated with 1.6 VIP or 1.9 VIP+PBSC. A relative dose intensity of 1.6 VIP was used in 14 patients and 11 patients received the intensity of 1.9 VIP. Clinical response was achieved in 56% of patients. Fifty-eight percent of patients have survived more than 1 year and 44% more than 2 years. No significant difference was noted between previously treated and untreated patients, as well as between the patients on 1.6 VIP and 1.9 VIP, with the exception of improved 1-year survival of patients on 1.9 VIP. One of four cisplatin-refractory patients achieved durable partial remission with a normal level of tumor markers. Serious non-hematological toxicity was rare. Myelotoxicity of 1.9 VIP was less serious in comparison with 1.6 VIP regimen, but the difference was not significant. Sequential intermediate high-dose therapy is an effective and tolerable regimen for patients with poor risk germ cell tumor as well as for relapsed patients.
中高剂量VIP方案（依托泊苷、异环磷酰胺、顺铂）与高剂量化疗加外周血干细胞移植相比，在预后不良的生殖细胞肿瘤中疗效相当且耐受性更佳。本研究的目的是在临床实践中证实该方案的有效性和耐受性。连续25例患者，其中9例既往未接受治疗且预后不良，16例复发，接受了1.6 VIP或1.9 VIP + 外周血干细胞移植治疗。14例患者采用1.6 VIP的相对剂量强度，11例患者接受1.9 VIP的剂量强度。56%的患者获得临床缓解。58%的患者存活超过1年，44%的患者存活超过2年。既往接受治疗和未接受治疗的患者之间，以及接受1.6 VIP和1.9 VIP治疗的患者之间，除了接受1.9 VIP治疗的患者1年生存率有所提高外，未发现显著差异。4例顺铂难治性患者中有1例实现了持久部分缓解，肿瘤标志物水平正常。严重的非血液学毒性罕见。与1.6 VIP方案相比，1.9 VIP的骨髓毒性较轻，但差异不显著。序贯中高剂量治疗对于预后不良的生殖细胞肿瘤患者以及复发患者是一种有效且耐受性良好的方案。
