Forty-four patients with nonseminomatous
germ cell tumors with "poor prognostic features" were entered on the
VAB-5 regimen and 38 are evaluable.
VAB-5 represents an intensified version of the
VAB-4 protocol. Poor prognostic features were considered to be bulky
metastases ( greater than 5 cm in diameter), palpable retroperitoneal
disease, liver metastases,
brain metastases, involvement of two or more parenchymal organs, pure
choriocarcinoma,
alpha fetoprotein or
human chorionic gonadotropin serum levels over 1000 ng/ml,
lactic acid dehydrogenase serum levels over 400 mg/dl, and failure to prior
chemotherapy. Eighteen of 38 evaluable patients became free of
neoplasm, 11 with
chemotherapy alone, and seven with combined
chemotherapy and surgery. Fourteen of 18 complete responders remain alive and free of disease with a median follow-up of 50 months. Complete remission with testis
tumor occurred in 13/15 without and 5/15 with prior
chemotherapy and in none of eight patients with primary extragonadal
germ cell tumors. Thirty-one patients received
antibiotics when they developed
fever during myelosuppression. Ten patients developed transient serum
creatinine levels over 2 mg/dl after
cis-platinum and one required
hemodialysis with subsequent recovery. All patients had severe
mucositis after induction. An apparent improvement of results over prior VAB protocols in patients with poor prognostic features was compromised by significant increases in toxicity and such patients require special study to improve cure rates.