Chemotherapy with adriamycin and vincristine alternated with cyclophosphamide and actinomycin D in testicular germ cell tumors refractory to cisplatin, vinblastine and bleomycin

Eighteen patients with testicular cancer refractory to cisplatin, vinblastine and bleomycin (PVB) were treated with a non-cross-resistant regimen including adriamycin, 60 mg/m² i.v. on day 1, and vincristine, 1.2 mg/m² i.v. on days 1 and 8, alternated q 3 weeks with cyclophosphamide, 600 mg/m² i.v. on days 1 and 8, and actinomycin D, 1 mg/m² i.v. on days 1 and 8. The median number of administered cycles was 8 (range 3-14). The results were analyzed according to previous response to PVB. One of two patients relapsing after the first-line therapy obtained a transient second complete response (CR) (duration 7 months). None of seven patients who showed no response to PVB obtained a CR; in 3 9 patients with a partial response (PR) after PVB, the achievement of CR could not be definitely attributed to salvage therapy. Toxicity was mild; no cardiac failure or drug-related deaths were observed. In conclusion, these two alternating regimens were well tolerated, but this treatment was not found to be useful in patients not responsive to PVB, for whom new and alternative therapies are required. The favorable impact on prognosis, evident only in the subgroup of patients with PR, was probably attributable to PVB rather than to this salvage regimen.