Chemotherapy of advanced malignant teratomas

Abstract

Between 1977 and November 1979 we have treated 53 patients with malignant teratomas (43 males, 10 females). Thirty (70%) out of the 43 male patients had advanced and bulky disease at the time of presentation. Using different drug combinations in a sequential manner as described below, results are as follows: of the initial 33 male patients, 22 (67%) have discontinued treatment (mean 9.5 months). Nineteen have responded completely and 3 have static computed tomography (CT) nodules. Life-table analysis projects a survival of 66% (analysis at 1 December 1979). Nine out of 10 ovarian teratoma patients are alive. Adverse prognostic factors at the start of treatment were recognized in 9/10 male patients and the 1 female patient who have died. Although the survival of patients with malignant teratomas has improved dramatically, there are still problems with drug resistance in patients with very advanced disease. Patients with these tumours should continue to be treated in centres specializing in managing what has now become a potentially curable disease in most cases.

Treatment of patients with poor prognosis anaplastic germ cell tumours (AGCT) of the testis and other sites

“…The most important finding was that patients with large volume metastatic disease had a significantly better survival if they received cisplatin at a dose of 120 mg/m2 compared to 75 mg/m2. This confirmed our earlier observation (Newlands et al, 1980) that patients with more advanced disease required a minimum of 360 mg/m2 of cisplatin in their combination chemotherapy to obtain a high proportion of stable remissions.…”

“…The chemotherapy schedules used have been reported previously (Newlands et al, 1980(Newlands et al, , 1983. The treatment was given in the following sequence: Two courses of POMB followed by ACE, then POMB is alternated with ACE until patients are in biochemical remission as measured by serum hCG and AFP.…”

Significance of the ‘maturation’ of metastases from germ cell tumours after intensive chemotherapy

“…A second controversial point has been the discrepancy between the high incidence reported for elevated serum concentrations of HCG and AFP in patients with non-seminomatous germ cell tumours (Newlands et al 1976, Newlands et al 1980, Javadpour 1979 and the relative rarity with which trophoblast and yolk sac are reported in pathological surveys (Mostofi & Price 1973, Pugh 1976. All seven patients in whom cyto-and syncytiotrophoblast (not necessarily arranged in pseudovillous fashion) were identified, had serum HCG levels > 103 when they presented with metastases, whereas the nine patients with syncytiotrophoblastic giant cells and no unmistakable cytotrophoblast had much lower serum HCG, which in three instances was close to normal.…”

“…Sequential correlation chemotherapy schedules included cis-diamine-dichloroplatinum (DDP), vincristine (oncovin), methotrexate and bleomycin (POMB), VP16-213 (Etoposide), Actinomycin D and cyclophosphamide (ACE) in all patients. Thirteen also had hydroxyurea, vinblastine and chlorambucil (Newlands et al 1980).…”

Short‐course Etoposide, Bleomycin and Cisplatin in the Treatment of Metastatic Germ Cell Tumours. Appraisal of its Potential as Adjuvant Chemotherapy for Stage 1 Testis Tumours

“…There has been considerable improvement in the results of chemotherapy for metastatic malignant teratoma during the last decade, with the overall results increasing from a 60% cure rate (Einhorn and Donohue, 1977;Newlands et al, 1980;Vugrin et al, 1981) in the first publication to 90%, due to increased experience and an awareness of the need for early treatment leading to earlier referral (Einhorn and Williams, 1980;Newlands et al, 1983;Vugrin et al, 1983;MRC Testicular Tumour Working Party Report, 1984). However, the treatment has always had a small risk of lethal toxicity, even in the most recently published series (Williams et al, 1987).…”