Newlands E S
Semin Oncol. 1985 Mar;12(1 Suppl 2):37-41.
VP-16 (VePesid) was incorporated into combinations for first-line treatment of patients with malignant germ-cell tumors or gestational choriocarcinoma. The basic combination consists of POMB (vincristine, methotrexate, bleomycin, and high-dose cis-platinum) and ACE (VP-16, actinomycin D, and cyclophosphamide). Patients receive two courses of POMB, then ACE, then POMB again. Patients with larger volume disease continue with POMB and ACE until biochemical remission is achieved, as indicated by tumor marker levels. Of 112 male patients with malignant germ-cell tumors, some of whom had previous radiotherapy or chemotherapy, and more than 50% of whom had advanced disease, the current survival rate is 87%. The survival rate is 77% for the worst-prognosis patient group. Patients with brain metastases from germ-cell tumors have not required surgery or radiotherapy to achieve a durable complete remission. Among patients who have multiple resistance to drugs such as vinblastine, bleomycin, and cis-platinum, 50% have achieved remission when treated with the EP/OMB schedule (VP-16 and cis-platinum alternated with vincristine, methotrexate, and bleomycin) repeated at short intervals. In 76 drug-resistant patients with gestational choriocarcinoma (medium risk), VP-16 was given intravenously (IV) 100 mg/m2/d for five days as initial therapy, with methotrexate given 11 to 13 days later. Overall response rate including partial response and improvement is 78%. In high-risk gestational choriocarcinoma patients, a weekly schedule of chemotherapy, alternating EMA (VP-16, methotrexate, actinomycin D, and folinic acid) with CO (vincristine and cyclophosphamide), has resulted in an overall survival of 84%; survival in patients who received previous chemotherapy is 73%; and survival in those who did not receive previous chemotherapy, 93%. Mucosal toxicity has not been a major problem. It is recommended that in patients with germ-cell tumors and in medium- and high-risk gestational choriocarcinoma patients, VP-16 be used in initial therapy and not be retained for relapse therapy only.
依托泊苷（威克）被纳入一线治疗方案，用于治疗恶性生殖细胞肿瘤或妊娠性绒毛膜癌患者。基本联合方案由POMB（长春新碱、甲氨蝶呤、博来霉素和大剂量顺铂）和ACE（依托泊苷、放线菌素D和环磷酰胺）组成。患者先接受两个疗程的POMB，然后是ACE，之后再接受POMB。对于疾病体积较大的患者，根据肿瘤标志物水平，持续进行POMB和ACE治疗，直至生化缓解。在112例恶性生殖细胞肿瘤男性患者中，部分患者曾接受过放疗或化疗，超过50%的患者患有晚期疾病，目前的生存率为87%。预后最差的患者组生存率为77%。患有生殖细胞肿瘤脑转移的患者无需手术或放疗即可实现持久的完全缓解。在对长春碱、博来霉素和顺铂等药物具有多重耐药性的患者中，50%的患者在短时间间隔重复使用EP/OMB方案（依托泊苷和顺铂与长春新碱、甲氨蝶呤和博来霉素交替使用）治疗后实现了缓解。在76例耐药性妊娠性绒毛膜癌（中度风险）患者中，初始治疗时静脉注射依托泊苷100mg/m²/d，持续5天，11至13天后给予甲氨蝶呤。包括部分缓解和病情改善在内的总体缓解率为78%。在高危妊娠性绒毛膜癌患者中，每周交替使用EMA（依托泊苷、甲氨蝶呤、放线菌素D和亚叶酸钙）和CO（长春新碱和环磷酰胺）的化疗方案，总体生存率为84%；既往接受过化疗的患者生存率为73%；未接受过化疗的患者生存率为93%。黏膜毒性并非主要问题。建议在生殖细胞肿瘤患者以及中度和高危妊娠性绒毛膜癌患者中，依托泊苷用于初始治疗，而不应仅保留用于复发治疗。
