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(“PEBOI”) beim disseminierten Hodenkarzinom mit ungünstiger Prognose Cisplatin/Etoposid/Bleomycin/Vincristin/Ifosfamid

  • A. Harstrick
  • H.-J. Schmoll
  • H. Wilke
  • T. Hecht
  • W. Siegert
  • A. Mayr
  • L. Bergmann
  • F. Natt
  • P. Reichardt
  • M. Klee
  • U. Lammers
  • U. Räth
  • J. Hohnloser
  • J. Preiß
  • H. P. Lohrmann
  • K. Gutberlett
  • M. Brandtner
  • G. Wegener
  • Ch. Wittekind
  • U. Jonas
  • H. Poliwoda
Conference paper

Zusammenfassung

Obwohl die Mehrzahl der Patienten mit nichtseminomatösen Hodentumoren durch cisplatinhaltige Kombinationsprotokolle geheilt werden können, haben Patienten mit weit fortgeschrittener Erkrankung nach wie vor eine schlechte Prognose. Im Oktober 1985 entwickelte daher die AIO-Studiengruppe für Hodentumoren ein neues 5er-Regime bestehend aus zwei alternierenden Blöcken für diese Hochrisikopatienten. Therapieplan: Block I: Cisplatin 50 mg/m2 Tag 1–3; Etoposid 170 mg/m2Tag 1–3; Bleomycin 15 mg/m2Tag 1, 8; Vincristin 1,4 mg/m2 Tag 1, 8; Block II: Tag 15, vorausgesetzt Granulozyten größer 500/μl; Ifosfamid 5 g/m2 24 Stunden kontinuierliche Infusion; Bleomycin 15 mg/m2 Tag 1, 8; Vincristin 1,4 mg/m2 Tag 1,8; q 28 Tage. Bis Februar 1988 wurden 54 Patienten nach diesem Protokoll behandelt, 9 davon waren chemotherapeutisch vorbehandelt, 3 erfüllten nicht die Definition für weit fortgeschrittene Erkrankung. Von den verbleibenden 42 Patienten wurden 5 für die Auswertung hinsichtlich des Ansprechens ausgeschlossen (3 × reines Seminom, 1 Frühtodesfall, 1 × Protokollverletzung). Von 37 auswertbaren Patienten befinden sich 4 noch in Therapie, 18/33 (54%) wurden tumorfrei durch Chemotherapie +/-Operation, 10/33 (31%) erreichten eine partielle Remission mit Normalisierung der Tumormarker. Nach einer medianen Beobachtungsdauer von 12 Monaten haben 3 Patienten ein Rezidiv erlitten; 29/33 (88%) Patienten leben, 25/33 (76%) ohne Hinweis auf Tumorprogreß und 15/33 (48%) tumorfrei. Die Toxizität bestand hauptsächlich in einer ausgeprägten Myelosuppression, war aber insgesamt tolerabel mit einem Therapie-assoziierten Todesfall. Insgesamt sind diese Ergebnisse mit denen anderer Hochrisikoprotokolle vergleichbar. Für Patienten mit weit fortgeschrittener Erkrankung sind die Resultate unbefriedigend und erfordern die Entwicklung neuer Therapiestrategien.

Abstract

Though the majority of patients with nonseminomatous germ cell tumors can be cured with Cisplatin-containing chemotherapy, patients with advanced disease still have a bad prognosis. Thus the AIO-Study Group for Testicular Cancer conducted a new protocol for these patients consisting of two alternatively given blocs of chemotherapy. Bloc I: Cisplatin 50 mg/m2 d 1–3, Etoposide 170 mg/m2 d 1–3, Bleomycin 15 mg/ m2 d 1 + 8, Vincristin 1,4 mg/m2 d 1, 8; Bloc II: (To be given on day 15 if granulocytes were above 500 per μl) Ifosfamide 5 g/m2 24 h cont. infusion, Bleomycin 15 mg/m2 d 1, 8, Vincristin 1,4 mg/m2 d 1, 8); q 28 days. Until February 1988 54 patients have been treated according to this protocol. 9 patients have had previous chemotherapy, 3 patients did not fit to the definition of “bulky disease”. Thus 42 eligible patients remained of whom 5 were not evaluable for response because of pure seminoma [3], early death [1] or protocol violation [1]. Of 37 evaluable patients 4 are still in therapy. 18/33 (54%) were rendered tumorfree by chemotherapy +/- surgical resection of residual masses. 10/33 (31%) achieved a partial remission with normalization of tumor markers but unresectable residual disease. Thus 85% had a favourable response. After a median observation time of 12 months, 3 patients have relapsed, 29/33 (88%) are still alive, 25/33 (76%) are alive without signs of tumor progression, 15/33 (48%) are continuously free of tumor. Toxicity consisted mainly of myelosupression and was tolerable with 1 therapy-associated death. These results are comparable with those achievable with other high risk protocols. For patients with very advanced disease these results are still unsatisfactory and warrant the development of new therapy strategies.

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Copyright information

© Springer-Verlag Berlin Heidelberg 1988

Authors and Affiliations

  • A. Harstrick
  • H.-J. Schmoll
  • H. Wilke
  • T. Hecht
  • W. Siegert
  • A. Mayr
  • L. Bergmann
  • F. Natt
  • P. Reichardt
  • M. Klee
  • U. Lammers
  • U. Räth
  • J. Hohnloser
  • J. Preiß
  • H. P. Lohrmann
  • K. Gutberlett
  • M. Brandtner
  • G. Wegener
  • Ch. Wittekind
  • U. Jonas
  • H. Poliwoda

There are no affiliations available

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