Treatment of persistent or relapsing advanced germ cell neoplasms with cisplatin, etoposide and bleomycin

Twenty-six patients, previously treated with cisplatin, vinblastine and bleomycin (pVB) had residual or recurrent germ cell tumors and were treated with cisplatin, etoposide and bleomycin (peB). Six patients obtained complete response and 11 patients partial response. Of the 11 patients with partial response 5 were disease free after post-chemotherapy surgery. Seven patients are still alive without evidence of disease with a median follow-up of 40 months (range 14+ - 57+ months). One patient died from acute non-lymphocytic leukemia without evidence of germ cell cancer. Toxicity was modest with only three patients having leukopenic fever. Retrospectively, the patients were analyzed in two groups according to their initial prognostic features. Thirteen patients were considered to have unfavourable prognostic factors and all had progress/relapse after treatment with peB. It is concluded that peB might be useful as first line therapy because of modest toxicity and considerable activity in pretreated patients and that more intensive therapy is necessary in patients with unfavourable prognostic features.