Chemotherapy of male and female germ cell tumors.

Germ cell tumors of testicular origin are virtually always curable with modern therapy that appropriately integrates chemotherapy and surgery. Clinical trials of chemotherapy in patients with disseminated disease now separate those with limited metastatic disease and an excellent prognosis from those with bulky tumor and a less favorable prognosis. In the former group, it has been shown that three courses of BEP (bleomycin/etoposide/cisplatin) are therapeutically comparable to four courses.

High-dose carboplatin and etoposide with autologous bone marrow transplantation in refractory germ cell cancer: an Eastern Cooperative Oncology Group protocol.

Purpose: A phase II trial was undertaken to assess the feasibility, toxicity, and efficacy of high-dose carboplatin and etoposide with autologous bone marrow transplantation in patients with relapsed or refractory germ cell tumors.

Patients And Methods: Forty patients with recurrent germ cell cancer received carboplatin 500 mg/m2 and etoposide 400 mg/m2 given at 7, 5, and 3 days before marrow infusion. Autologous marrow infusion (day 0) was accomplished using one half of the bone marrow harvested before chemotherapy.

Etoposide, ifosfamide, and cisplatin in extensive small cell lung cancer.

From December 1987 through April 1989, 40 patients with extensive-stage small cell carcinoma of the lung were enrolled in a Hoosier Oncology Group (HOG) trial using etoposide, ifosfamide, and cisplatin (VIP). Patients with extensive disease were eligible if they had not received prior chemotherapy, had a Karnofsky performance status of 50 or more, and had adequate renal function (creatinine, less than 1.5 mg/dl) and bone marrow reserve (granulocyte count, greater than or equal to 2500/microliters; platelets, greater than or equal to 125,000/microliters).

Clinical trials with ifosfamide: the Indiana University experience.

At Indiana University, we began clinical trials with ifosfamide in 1981. Although our initial efforts were in a variety of tumor types, including pancreatic cancer, we have most recently focused our attention on two tumors that have historically exhibited a higher degree of chemosensitivity--testicular cancer and small cell lung cancer (SCLC). In phase II trials, ifosfamide has proven to have single-agent activity in both diseases.

Humoral hypercalcemia in seminomas.

Seminomas are germ cell tumors that are rarely associated with hypercalcemia. In this report, four cases of seminoma with concomitant hypercalcemia are presented and another three from the literature are reviewed. All seven patients exhibited hypercalcemia with a normal serum concentration of inorganic phosphorus and no evidence of skeletal metastases.

Chemotherapy for advanced testicular cancer.

Testis cancer has become one of the most curable of all solid malignancies. More than 95% of patients should be cured with appropriate treatment and should have few long-term treatment-related side effects. Current chemotherapy for advanced testis cancer has resulted from an orderly sequence of chemotherapy trials that serves as a model for cancer chemotherapy development.

Salvage therapy in recurrent germ cell cancer.

Testicular cancer is an important malignancy, not only because it has high curative potential with surgical resection (in local disease) and chemotherapy (in metastatic disease), but also because it serves as a pre-eminent example of the successful linkage between preclinical and clinical research experience. Improvements in salvage therapy have resulted in important advances in first-line therapy in germ cell cancer. Testicular cancer remains one of the few solid tumors in which a curative approach may be taken in patients who are not cured with initial induction chemotherapy.

Mediastinal yolk sac tumor. The Indiana University experience, 1976 to 1988.

Mediastinal yolk sac tumor (endodermal sinus tumor) is an extremely rare extragonadal germ cell neoplasm that has been associated with a grave prognosis. Twenty-one male patients with mediastinal yolk sac tumor received treatment at Indiana University between 1976 and 1988. Fourteen were seen after initial diagnosis, and their disease was treated with cisplatin-based chemotherapy in association with complete surgical resection if possible.

Knowledge and beliefs about cancer in a socioeconomically disadvantaged population.

Americans living in poverty experience a higher incidence of and greater mortality from cancer than the nonpoor. At least 50% of the difference in mortality is believed to be due to delay in diagnosis, although risk-promoting lifestyles and behaviors also contribute to decreased survival. A potential exacerbating factor among the poor is inadequate information and knowledge about cancer and its treatment.

Phase II trial of daily oral etoposide in patients with advanced non-small cell lung cancer.

Forty-six previously untreated patients with advanced non-small cell lung cancer (NSCLC) were entered into a Hoosier Oncology Group phase II trial of daily oral etoposide 50 mg/m2/d. The dose limiting toxicity was granulocytopenia. The non-hematologic toxicity was mild, with only 19% of patients developing Grade 3 or 4 leukopenia.

Randomized study of cisplatin dose intensity in poor-risk germ cell tumors: a Southeastern Cancer Study Group and Southwest Oncology Group protocol.

Between 1984 and 1989, 159 patients presenting with advanced germ cell cancer were entered on a randomized clinical trial comparing the efficacy and toxicity of etoposide and bleomycin and either standard-dose cisplatin (20 mg/m2 daily for 5 days) or high-dose cisplatin (40 mg/m2 daily for 5 days). Of the 159 patients, 153 were assessable for toxicity and response. As expected, patients receiving the high-dose cisplatin regimen experienced significantly more neurotoxicity, ototoxicity, nausea and vomiting, and myelo-suppression.

Etoposide therapy for testicular cancer.

During the past two decades, dramatic strides have been made in the treatment of metastatic testicular cancer. In the early 1970s, cisplatin, vinblastine, and bleomycin (PVB) produced durable complete remissions (CR) in approximately 70% of treated patients. In the early 1980s, etoposide emerged as the only drug with single-agent activity in cisplatin-refractory patients.

Clinical trials in cancer therapy: efforts to improve patient enrollment by community oncologists.

A prerequisite for the completion of a clinical trial is the accrual of adequate numbers of patients. It is estimated that over 90-95% of all cancer patients are now treated in their local communities by practicing oncologists and are not seen by primary investigators at teaching hospitals. One risk of this trend is decreased patient enrollment into clinical trials.

Breast cancer screening in older women: practices and barriers reported by primary care physicians.

Annual mammography, in combination with clinical breast examinations, can reduce mortality from breast cancer. However, surveys of both patients and physicians suggest that mammography is underutilized. This study examined whether physicians' reported breast cancer screening practices and barriers to mammography varied with patients' age.

High dose carboplatin/VP-16 plus ifosfamide with autologous bone marrow support in the treatment of refractory germ cell tumors.

We report seven patients with germ cell tumors which either recurred following a minimum of two regimens of platinum-based chemotherapy or were refractory to cisplatin. The patients were treated with one or two courses of high dose carboplatin (CBDCA) and etoposide (VP-16) plus ifosfamide (IFX) with mesna uroprotection and autologous bone marrow support. The doses given were CBDCA 500 mg/m2 every other day x 3 and VP-16 400 mg/m2 every other day x 3.

Perioperative methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC) for poor risk transitional cell carcinoma of the bladder: an Eastern Cooperative Oncology Group pilot study.

A total of 18 patients with locally advanced transitional cell carcinoma of the bladder underwent 2 preoperative cycles of chemotherapy with methotrexate, vinblastine, doxorubicin and cisplatin followed by radical cystectomy and 2 postoperative cycles of chemotherapy. Radical cystectomy was performed in 17 of 18 patients (94%) with a pathological partial response in 3 (17%) and a pathological complete response in 2 (11%), for an over-all response rate of 28% (95% confidence limits 10 to 53%). At 23-month median followup 9 patients (50%) remained without evidence of recurrent disease, while 9 (50%) died of metastatic bladder cancer.

Chemotherapy for advanced thymoma. Preliminary results of an intergroup study.

Objective: To determine the efficacy of combination therapy with cisplatin, doxorubicin, and cyclophosphamide alone or with radiotherapy for patients with extensive and those with limited unresectable thymoma.

Design: Nonrandomized, prospective phase I-II trial.

Setting: A Cooperative Oncology Group trial involving tertiary medical centers.

Hepatic resection for disseminated germ cell carcinoma.

Improvements in operative technique and perioperative management have expanded the application of hepatic resection for metastatic cancer. Although a policy of aggressive surgical resection of residual pulmonary and retroperitoneal disease following chemotherapy and normalization of serum tumor markers has been adopted for disseminated germ cell carcinoma, resection of residual hepatic disease in these cases has not been addressed. This report concerns a series of prospectively randomized patients who received systemic cisplatin-based chemotherapy for testis cancer during the past 13 years.

Ifosfamide in testicular cancer.

Ifosfamide has demonstrated significant activity as salvage therapy in patients with testicular tumors refractory to cisplatin-containing induction chemotherapy regimens. Used as a single agent, ifosfamide produces objective responses in approximately 1 of 5 heavily pretreated patients failing to respond to any other agents. When ifosfamide is administered in combination with cisplatin and other agents, approximately 40% to 50% of pretreated patients with recurrent germ cell tumors achieve a complete remission.

Primary mediastinal nonseminomatous germ cell tumors. A modern single institution experience.

Between 1976 and 1988, 31 patients with mediastinal nonseminomatous germ cell tumors (MNGCT) received initial cisplatin-based chemotherapy of uniform intensity. Eighteen of these patients (58%) obtained disease-free status; 11 with chemotherapy alone and seven with adjunctive surgery. Eleven have remained continuously free of disease.

Spindle cell tumors resected from male patients with germ cell tumors. A clinicopathologic study of 14 cases.

We identified 14 male germ cell tumor patients (13 of whom had received prior chemotherapy) in whom distinctive neoplasms composed of spindle to stellate cells set in a myxoid to collagenous stroma containing numerous blood vessels developed. These neoplasms were cytokeratin-positive and vimentin-positive and alpha-fetoprotein (AFP)-negative. Ten patients with neoplasms of low cellularity and no mitoses have not had tumor recurrences, whereas four patients with more cellular and mitotically active tumors have experienced either recurrences or death.

Ifosfamide plus doxorubicin in metastatic adult sarcomas: a multi-institutional phase II trial.

Between April 1986 and March 1987, 42 patients with advanced sarcoma were entered in this multi-institutional trial evaluating ifosfamide plus doxorubicin. The majority of patients had leiomyosarcoma and malignant fibrous histiocytoma although two patients with sarcomas of osseous origin were included. Doxorubicin was administered at a dosage of 60 mg/m2 by continuous push and ifosfamide 5.

Management of postchemotherapy residual mass in patients with advanced seminoma: Indiana University experience.

Thirty-six patients with advanced seminoma treated with cisplatin combination chemotherapy were evaluated to assess the significance of postchemotherapy residual radiographic mass. All patients had a minimum follow-up of 2 years. Of the 36 patients 21 had an evaluable residual radiographic mass after completion of chemotherapy.