Treatment of poor-risk germ-cell tumors with high-dose cisplatin and etoposide combined with bleomycin

Seventy-two patients with far advanced ('high-risk') germ-cell tumors were treated with cisplatin 40 mg/m2 i.v. and etoposide 200 mg/m2 i.v. daily for 5 days and bleomycin 15 mg/m2 i.v. once a week. At least 3 cycles of this treatment were given at three-week intervals to all patients. Seventy-five percent of the patients obtained CR and 67% are without evidence of disease after a median observation time of 47 months (range 5 to 80 months). Hematologic toxicity was severe and 10% of the patients died due to treatment-related toxicity. Neurotoxicity was a clinical problem in 58% of the patients. Glomerular filtration rate decreased significantly after 3 cycles (29% +/- 16%). No clinically significant pulmonary toxicity was observed. The specific role of high-dose cisplatin in such intensive treatment has until now been the subject of only one randomized study in which no superiority of high-dose cisplatin was found. Significant improvement of therapeutic outcome over that of today's standard treatment conceivably necessitates an even greater increase in dose intensity of the active drugs--or inclusion of new drugs.