Journal of Clinical Oncology, Vol 4, 528-536, Copyright © 1986 by American Society of Clinical Oncology
VP-16 plus ifosfamide plus cisplatin as salvage therapy in refractory germ cell cancer
Sr Loehrer PJ, LH Einhorn and SD Williams
Forty-eight evaluable male patients with germ cell tumors (GCT) failing to
be cured with first-line therapy were treated with VP-16 (75 mg/m2),
ifosfamide (1.2 g/m2), and cisplatin (20 mg/m2) (VIP), all given daily for
5 consecutive days every 3 weeks. All patients either achieved an
unresectable partial remission as their best response to induction
chemotherapy (Group A), relapsed from complete remission (CR) less than or
equal to 2 months after induction therapy (Group B), or had received
cisplatin plus VP-16 as previous salvage therapy (Group C). Nine (19%) had
extragonadal GCT, and 37 (77%) had advanced disease. Twenty-three (48%) of
the patients had greater than or equal 2 prior treatment regimens. Sixteen
of 48 (33%) achieved CR with VIP treatment alone or following surgical
excision of residual disease. Six of 22 (27%), three of seven (43%), and
seven of 19 (37%) patients from groups A, B, and C, respectively, attained
a CR. The median survival time of all patients was 7 months (range 0 to
28+) with seven patients remaining continuously free of disease (four
patients greater than 1 year). Myelosuppression was significant with a
median WBC nadir of 900/mm2 and platelet nadir of 24,000/mm2. Fourteen
(26%) had granulocytopenic fever, and renal insufficiency developed in 15%.
VIP combination chemotherapy demonstrates activity in this highly
unfavorable population of patients with germ cell tumors. The actual
contribution of ifosfamide in this regimen is unclear, but these results
compare favorably to our experience with similar patients treated with
cisplatin plus VP-16 alone. Further studies with VIP as initial salvage
therapy for patients with GCT are planned.
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