Sequential trials of cisplatin, vinblastine, and bleomycin and etoposide and cisplatin in disseminated nonseminomatous germ cell tumors of the testis with a good prognosis at a single institution.

Background: With the introduction of cisplatin-based chemotherapy, approximately 80% of patients with disseminated nonseminomatous germ cell tumors (NSGCT) of the testis can be cured. These treatments have been associated with considerable toxic effects. Numerous trials have been performed with the challenge of minimizing toxic effects without jeopardizing prognosis in a subgroup of these patients with a good prognosis.

Methods: A retrospective study comparing the efficacy and toxic effects of etoposide and cisplatin (EP) and cisplatin, vinblastine, and bleomycin (PVB) was done in two consecutive groups of patients who had comparable characteristics and disseminated NSGCT of the testis with a good prognosis.

Results: Twenty of 22 (91%) patients receiving EP and 19 of 19 (100%) receiving PVB achieved a complete response with or without adjunctive surgery. At surgery, similar proportions of patients in both groups were found to have mature teratoma or fibrosis and necrosis. With a median follow-up of 111 months (PVB-treated group) and 43 months (EP-treated group), the actuarial overall survival was similar in both groups. One patient treated with PVB and five patients receiving EP had relapses. The recurrence-free survival was almost significantly higher with PVB than with EP (P = 0.054). Only patients in the PVB-treated group had pulmonary (5.5%) and cutaneous (16%) toxic effects. No differences regarding hematologic, neurologic, and renal toxic effects were found.

Conclusions: The omission of bleomycin in first-line therapy for disseminated NSGCT with a good prognosis should be adopted with caution because it seems to affect the therapeutic outcome, with more patients having relapses.