The combination of
platinum,
vinblastine, and
bleomycin was first used at Indiana University in 1974. Thirty of 47 patients (64%) survived for 5 years, and 27 (57%) are currently disease free (NED) and cured of their
neoplasm. From 1976 to 1978, 78 consecutive patients were entered on a random prospective study that indicated that equal therapeutic results could be achieved with a lower dosage (0.3 mg/kg) of
vinblastine. Fifty-two (67%) patients are continuously NED, and 57 (73%) are currently NED for 2 or more years. Our third-generation study, done in conjunction with the Southeastern
Cancer Study Group, tested the hypothesis of whether maintenance
vinblastine was necessary to ensure optimal cure rates in disseminated
testicular cancer. One hundred thirteen patients entered this maintenance study, and the results demonstrated that cure in a far-advanced
cancer could be achieved with only 12 weeks of
therapy (
remission induction) because the relapse rate in such patients was only 7%. The cure rate for patients presenting with locoregional disease (Stages A and B) should approach 100%.
Platinum,
vinblastine, and
bleomycin will regularly produce a 70% complete remission rate, and a further 10% of patients will be rendered NED with surgical resection of residual disease. The relapse rate with four courses of
remission induction therapy in a large cooperative group study (Southeastern
Cancer Study Group) was only 7%. The high success rate in disseminated disease has allowed the option of high cure rate in Stage B disease (positive retroperitoneal nodes) with or without
adjuvant chemotherapy. At Indiana University, 137 patients have been followed with Stage A and B nonseminomatous
testicular cancer from 1973 to 1979 with a minimum follow-up of 2 years, and currently 135 are alive and well. Successful treatment strategies in
testicular cancer have yielded a cure rate unparalleled in
cancer treatment.