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Ifosfamide in testicular cancer: the Indiana University experience
P J Loehrer1, S D Williams, L H Einhorn
1Section of Hematology/Oncology, Indiana University School of Medicine, Indiana University Hospital, Indianapolis 46223.
Abstract:
The systemic treatment of patients with metastatic germ cell tumors has improved dramatically during the past 15 years. Nonetheless, a cohort of patients are candidates for salvage chemotherapy. Having ruled out the possibility of pseudoprogression (eg, false elevated serum markers, teratoma, bleomycin lung disease), salvage therapy is indicated. Numerous trials in Europe and at Indiana University have confirmed single-agent activity of ifosfamide in patients with refractory germ cell tumors. As a consequence, a trial evaluating VeIP (vinblastine, ifosfamide, cisplatin) and VIP (etoposide, ifosfamide, cisplatin) was undertaken in 57 patients previously not cured with cisplatin, vinblastine, and etoposide regimens. Twenty patients achieved disease-free status with chemotherapy alone (n = 12) or chemotherapy plus surgical resection of residual carcinoma or teratoma (n = 8). Fifteen of these 20 patients remained free of recurrent disease from 18 to 53 months, including seven patients in continuous remission for over 2 years. Ifosfamide combination chemotherapy has curative potential in this heavily pretreated population. Further work to determine the role of ifosfamide in initial therapy is under way.
Insights
Salvage chemotherapy with ifosfamide-containing regimens like VeIP and VIP shows curative potential for refractory germ cell tumors. This approach offers hope for patients previously unresponsive to standard cisplatin-based treatments.
Area of Science:
- Oncology
- Medical Chemotherapy
Background:
- Metastatic germ cell tumors (GCTs) have seen improved systemic treatment outcomes.
- A subset of GCT patients require salvage chemotherapy after initial treatment failure.
- Pseudoprogression must be excluded before initiating salvage therapy.
Purpose of the Study:
- To evaluate the efficacy of ifosfamide-based salvage chemotherapy regimens in refractory GCT patients.
- To assess the curative potential of VeIP (vinblastine, ifosfamide, cisplatin) and VIP (etoposide, ifosfamide, cisplatin) regimens.
Main Methods:
- A clinical trial was conducted involving 57 patients with GCTs previously treated with cisplatin, vinblastine, and etoposide.
- Patients received either VeIP or VIP chemotherapy.
- Response was assessed, including disease-free status achieved through chemotherapy alone or with subsequent surgical resection.
Main Results:
- Twenty out of 57 patients achieved disease-free status (12 with chemotherapy alone, 8 with chemotherapy plus surgery).
- Fifteen of these 20 patients remained recurrence-free for 18 to 53 months.
- Seven patients achieved continuous remission for over two years.
Conclusions:
- Ifosfamide combination chemotherapy demonstrates curative potential in heavily pretreated GCT patients.
- Salvage therapy with VeIP and VIP regimens is effective for refractory germ cell tumors.
- Further research is ongoing to explore ifosfamide's role in initial GCT therapy.