The effect of a 7-day delay in chemotherapy cycles on complete response and event-free survival in good-risk disseminated germ cell tumor patients

Article Abstract:

Patients with disseminated germ cell tumors have a relatively good prognosis. From 70 to 80 percent of such patients are likely to achieve a complete response from a chemotherapeutic regimen that includes high-dose cisplatin. The toxic effects of such treatment is high, however, and patients may die from infections that their chemotherapy-crippled immune systems cannot fight off. For this reason, the primary focus of research into chemotherapy for tumors is not the improvement of response rates, but the reduction in toxic effects. During the period from November 1982 to July 1986, 162 patients with disseminated germ cell tumors were treated with either the VAB-6 protocol (cyclophosphamide, vinblastine, bleomycin, dactinomycin, and cisplatin) or the EP protocol (etoposide and cisplatin). Treatment cycles were postponed up to seven days if the patient's white blood cell count was below 3,000 per cubic millimeter or if the platelet count was below 100,000 per cubic millimeter. After seven days, the next chemotherapy cycle was begun regardless of the blood counts. The rationale was to provide some recovery time for the bone marrow before the next toxic insult was administered. The response rate and overall survival were compared among patients with different overall lengths of chemotherapy. The analysis showed that patients whose chemotherapeutic cycles had been delayed up to seven days did not differ significantly from those with no delay or a shorter delay. Neither the complete response rate or the survival of the patients appeared to be affected by the delay. The overall complete response rate was 94 percent for these patients, and 84 percent remain disease-free. The results indicate that delays up to seven days between chemotherapeutic cycles may reduce toxicity, but have no adverse effect on the therapeutic response for ''good-risk'' patients with disseminated germ cell tumors. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dosage and administration, Chemotherapy, Combination, Combination chemotherapy, Cisplatin

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Salvage chemotherapy for patients with germ cell tumors: the Memorial Sloan-Kettering Cancer Center experience (1979-1989)

Article Abstract:

Germ cell tumors are generally responsive to cisplatin-containing chemotherapy, but between 20 and 30 percent of patients will either not have a complete response to chemotherapy or will relapse after a complete response. These patients require salvage therapy. The authors present their experience in the salvage chemotherapy of 94 patients who either failed to respond completely or relapsed after induction chemotherapy. Several factors were identified which seemed to influence the outcome of the disease. Patients who had previously achieved a complete response and relapsed did better than patients who had failed induction therapy. Patients for whom a testis was the primary tumor site did significantly better, as did patients with only one metastasis. Normal serum levels of chorionic gonadotropin and lactic dehydrogenase also indicated better chances for survival. Of the patients who failed to achieve a complete response to induction chemotherapy, 9 percent are alive after an average follow-up of 37 months. In contrast, 36 percent of the patients who initially achieved a complete response, but who relapsed, are still alive after an average 35 months of follow-up. The results indicate that continued investigation of new salvage chemotherapy techniques is still necessary, particularly for patients who fail to achieve a complete response to induction chemotherapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management

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Carboplatin, etoposide, and bleomycin for patients with poor-risk germ cell tumors

Article Abstract:

The overall response rate to chemotherapy for patients with disseminated germ cell tumors is good. However, for the 20 to 30 percent of patients who do not achieve a complete response at initial chemotherapy, most will die of their disease. Previously, a mathematical model was developed to predict which patients were likely to fail to respond to conventional chemotherapy in the hope of providing more aggressive therapy for these patients from the very outset. In a prospective study, 32 patients identified as high-risk were treated with carboplatin, etoposide, and bleomycin. Nineteen patients achieved a complete response, and 14 of those continue to remain free of disease. These results are comparable with responses achieved using other regimens for the treatment of high-risk patients, indicating that the carboplatin-etoposide-bleomycin treatment does not improve patient response or survival. However, significantly fewer toxic side effects were observed than are expected with cisplatin, another agent used to treat these tumors. While the need for improved therapy for patients with poor-risk germ cell tumors remains, the ability of the present regimen to maintain effectiveness while lowering side effects warrants further evaluation and study. (Consumer Summary produced by Reliance Medical Information, Inc.)

Testicular cancer, Bleomycin, Etoposide, Carboplatin

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