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Sequentiell alternierende Chemotherapie nicht-seminomatöser Hodentumoren mit Velbe/Bleomycin und Adriamycin/Cisplatin

I. Ergebnisse einer randomisierten Studie bei 71 Patienten mit pulmonaler Metastasierung (Stadium IV)

Sequential combination chemotherapy with vinblastine/bleomycin and adriamycin/Cis-Dichlorodiammineplatinum (II) in Non-seminomatous Testicular Cancer

I. Results of a prospective randomized phase III-study with 71 patients with disseminated disease (stage IV)

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Summary

74 patients with disseminated non-seminomatous testicular cancer were randomly entered on a prospective sequential combination chemotherapy regimen with mandatory crossover, consisting of either vinblastine/bleomycin or adriamycin/cis-dichlorodiammineplatinum (II) (DDP) as initial therapy. Independent of the randomization the overall remission rate in 71 evaluable patients was 89% including 54% complete remissions. 35% of the patients remained disease-free at 2+ to 28+ months with a median of 12 months. By additional surgical removal of residual pulmonary metastases in two patients the complete remission rate was increased to 40/71 (56%), and the number of patients with no evidence of disease to 27/71 (38%). According to the life-table method the two-years survival rates were 63% for complete responders and 29% for all other patients, which was significantly lower. 53 patients (75%) were alive at 3 to 28 months with a median of 9 months. Additional advanced abdominal disease, initially elevated β-HCG and LDH and extension of pulmonary disease were of significant negative influence on the prognosis. The evaluation of single chemotherapy courses revealed equal efficacy of both combinations. However, response to adriamycin/DDP occurred in 46% of the courses, when vinblastine/bleomycin had failed, while response to vinblastine/bleomycin occurred only in 21% of the courses when adriamycin/DDP had failed. Thus different patterns of cross-resistance between these alternative regimens may exist.

Zusammenfassung

Vierundsiebzig Patienten mit pulmonal metastasierten nicht-seminomatösen Hodentumoren wurden im Rahmen einer prospektiven randomisierten Phase III-Studie sequentiell alternierend mit Velbe/Bleomycin und Adriamycin/Cisplatin behandelt. Unabhängig von der Randomisierung der initialen Zytostatika-Kombination wurden bei 71 auswertbaren Patienten bei einer Ansprechrate von 89% in 54% der Fälle Vollremissionen erzielt, die bei 35% der Patienten zwischen 2+ und 28+ Monaten mit einem Median von 12 Monaten andauerten. Durch zusätzliche operative Entfernung residueller pulmonaler Solitärmetastasen wurde die Vollremissionsrate auf 40/71 (56%) und die Anzahl der andauernden Vollremissionen auf 27/71 (38%) erhöht. Die Zwei-Jahres-Überlebensrate betrug nach der „Life-table“-Methode 63% bei den Patienten, bei denen eine Vollremission erreicht wurde, und war mit 29% bei den übrigen Patienten statistisch signifikant niedriger. Dreiundfünfzig Patienten (75%) waren bei einer mittleren Überlebenszeit von 9 Monaten zwischen 3 und 28 Monaten am Leben. Zusätzliche fortgeschrittene abdominelle Metastasierung, initial erhöhte β-HCG-und LDH-Werte und das Ausmaß der pulmonalen Metastasierung beeinflußten die Prognose statistisch signifikant negativ. Die Auswertung der einzelnen Chemotherapie-Kurse zeigte, daß beide Zytostatika-Kombinationen gleich wirksam waren. Dabei war jedoch ein Ansprechen auf Adriamycin/Cisplatin in 46% der Fälle nachweisbar, in denen Velbe/Bleomycin versagt hatte, während Velbe/Bleomycin nur bei 21% der Fälle wirksam war, in denen Adriamycin/Cisplatin zu keinem Ansprechen geführt hatte. Eine unterschiedlich ausgeprägte Kreuzresistenz zwischen den beiden Zytostatika-Kombinationen muß daher angenommen werden.

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Authors and Affiliations

  1. Westdeutsches Tumorzentrum, Innere Universitätsklinik und Poliklinik (Tumorforschung) Essen, Germany

    M. E. Scheulen, M. Higi, R. B. Schilcher, C. R. Meier, S. Seeber &  C. G. Schmidt

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  1. M. E. Scheulen
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  2. M. Higi
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  3. R. B. Schilcher
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  4. C. R. Meier
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  5. S. Seeber
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  6. C. G. Schmidt
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Mit Unterstützung der Deutschen Forschungsgemeinschaft: Teilprojekt C3B des Sonderforschungsbereichs 102: Experimentelle Leukämie- und Tumorforschung

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Scheulen, M.E., Higi, M., Schilcher, R.B. et al. Sequentiell alternierende Chemotherapie nicht-seminomatöser Hodentumoren mit Velbe/Bleomycin und Adriamycin/Cisplatin. Klin Wochenschr 58, 811–821 (1980). https://doi.org/10.1007/BF01491101

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  • DOI: https://doi.org/10.1007/BF01491101

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