Cisplatin combination chemotherapy for advanced germ-cell testicular tumours.

Thirty-six patients with advanced non-seminomatous germ-cell testicular tumours and two patients with advanced seminomas were treated with cisplatin-containing combination chemotherapy. Thirty-four patients received cisplatin 100 mg/m2 iv, vinblastine 0.3 mg/kg iv and bleomycin 30 mg iv (PVB) and three patients received this combination with etoposide (VP16-213) 120 mg/m2 iv on 3 consecutive days substituted for vinblastine (BEP). One patient received cisplatin and bleomycin only. All 35 evaluable patients with non-seminomatous tumours responded; 22 patients (61%) achieved a complete response (CR); 16 of these (73%) are alive with no evidence of disease at follow-up ranging from 18 to 55 months (median 36). Of 13 patients achieving a partial response (PR), 11 have died of progressive disease at 7 to 30 months (median 11) and two are alive with disease which has continued to regress following chemotherapy. Of 32 patients who received adequate chemotherapy, 16 (50%) are alive and disease-free and three (9%) are alive with evidence of disease. The chances of achieving a CR were reduced in those patients with bulky disease or high levels of AFP or beta hCG at presentation but not in those who had received prior radiotherapy. Toxicity was considerable, including alopecia and nausea or vomiting in all patients, and haematological toxicity, neurotoxicity, hearing loss and dyspnoea in a substantial number of patients.