Reversal of recurrent laryngeal nerve palsy following VP16-213 combination therapy in a patient with metastatic teratoma of the testis.

Two years after para-aortic node radiotherapy following removal of a non seminomatous germ cell tumour (NSGCT) of the left testis, M.R., a 32 year old caucasian male developed haemoptysis and a hoarse voice. Chest x-ray revealed a left hilar mass and serum alphafoetoprotein (AFP) and beta-human chorionic gonadotrophin (beta HCG) levels were elevated. In spite of VB3 [1] therapy plus cis-platinum and mediastinal radiotherapy his voice remained hoarse, although serum markers returned to normal, and the hilar mass was reduced in size. Four months after stopping therapy serum AFP levels began to rise, although no clinical evidence of recurrence could be discovered in abdomen, brain or chest. Chemotherapy was restarted using VP16-213 + bleomycin + cis platinum [2]. After the first course of therapy the serum AFP level fell to normal and his hoarse voice disappeared. The patient received five courses of the above regimen, following which complete remission has been maintained for 7 months to date. This case suggest that VP16-213 combined with bleomycin + cis-platinum has great activity against NSGCT of the testis and may have a different spectrum of activity from vinblastine, bleomycin, and cis-platinum, making it a valuable addition to the drugs available for the management of these tumours. In this patient it would seem the complete eradication of the metastatic mass allowed complete and immediate recovery of function of the trapped nerve in spite of it having been paralysed for 15 months.