Cisplatin,
vinblastine and
bleomycin (PVB) is very effective
therapy in disseminated
testicular cancer, but toxicity is severe. A further reduction of
vinblastine might reduce the acute toxicity of PVB without compromising the response rate in good-risk patients. Starting in March 1982, 42 consecutive patients with minimal or intermediate advanced disease (
lymph node metastases less than 10 cm, lung nodules less than 5 cm) began a 0.2-mg/kg
vinblastine PVB regimen, provided that serum
alpha-fetoprotein (AFP) levels were not greater than 1000 ng/ml and
human chorionic gonadotropin (HCG) values were not greater than 50,000 mIU/ml. Only 9 patients (21.4%) had leukocyte counts less than 1000/mm3, 6 (14%) had
infections, but none had documented
sepsis. Gastrointestinal and neuromuscular toxicities were mild. Of the 42 patients, 41 (97.6%) entered complete remission (CR), 8 with surgery. After a median follow-up period of 26 months (range, 19-40 months), 35 patients (83.3%) are continuously disease-free. Of the 6 patients with AFP levels greater than 400 ng/ml and/or HCG values greater than 1000 mIU/ml, only 2 (33.3%) entered continuous CR, versus 33 (91.6%) of the 36 patients with normal or less elevated markers (P less than 0.01). PVB with a 0.2-mg/kg
vinblastine dosage is very effective and well-tolerated
therapy in selected good-risk patients with disseminated germinal
testis cancer.