The VAB-6 regimen in the treatment of metastatic seminoma

Abstract

In an attempt to improve complete remission rates, seven patients with Stage III or bulky Stage II pure seminoma of the testis were treated with the VAB‐6 regimen. Cyclophosphamide 600 mg/m2 of body surface, vinblastine 4 mg/m2, dactinomycin 1 mg/m2, and bleomycin 30 mg were given by intravenous (IV) push on the first day. This was immediately followed by 3 days of continuous bleomycin infusion (20 mg/m2/day × 3) and cisplatin 120 mg/m2 IV over 20 to 30 minutes on the fourth day. Induction was repeated three more times. All patients achieved complete remission with chemotherapy alone. Five patients remain in CR 38, 36, 30, 29, and 19 months, respectively, and two relapsed 9 and 18 months, respectively, from beginning of chemotherapy. One patient required broad spectrum antibiotics for fever during severe myelosuppression. One patient developed temporary elevation of serum creatinine to 4 mg/dl after the second treatment with platinum, and was given reduced platinum doses with subsequent inductions. The VAB‐6 regimen is effective in the treatment of advanced metastatic seminoma.

Chemotherapy of metastatic seminoma

“…Similar to other reports, adjuvant retroperitoneal lymph node dissection after chemotherapy as carried out in 6/14 of the initially ,B-hCG positive, bulky disease patients might be of only limited value since microscopic tumour residues were discovered in none of these patients (Vugrin & Whitmore, 1984;Samuels et al, 1980). In addition, complete lymphadenectomy was difficult to perform because of the apparently dense fibrous tissue found in the retroperitoneal area.…”

“…Besides some early trials reporting on the sensitivity of metastatic seminomas to single agent chemotherapy, recent studies, mostly utilizing cisplatin containing regimens originally employed for the treatment of nonseminomatous testicular cancer have described a 50-70% or even higher complete remission rate (Ball et al, 1982;Mendenhall et al, 1981;Vugrin & Whitmore, 1984). However, most series contained only a small number of patients, thereby precluding any definitive conclusion on the value of the regimens used.…”

Long‐term survival in patients treated for testicular seminoma

“…), frequency of falsenegative staging will be reduced to the point where prophylactic RT could be omitted. This could be feasible because of added assurance that currently available chemotherapy is capable of eliminating disseminated disease [4], which may occur in some patients because of omission of RT and presence of unrecognized retroperitoneal metastases in clinical Stage I. Nine (25%) patients had RPLND, which documented pathologic Stage I disease.…”

“…Long-term survival range for patients with Stage 111 seminoma treated with radiation alone has been as low as 20% [6]. Although chemotherapy represented a rational alternative choice of therapy for these patients, it was not until the introduction of cisplatin, vinblastin, and bleomycin types of combination chemotherapies that chemotherapy was capable of achieving high complete remission rates [4,7]. Five of our six patients were treated with chemotherapy, with excellent results.…”