Probable cure of metastatic testicular tumors treated with sequential therapy

This clinical trial explores the possibility of inducing long-term unmaintained complete remissions in testicular cancer using sequential multimodality therapy. We designed a prospective study using a combination of vinblastine and bleomycin for three courses followed by cis-dichlorodiammineplatinum(II), actinomycin D, and vincristine until a surgically proven complete remission was achieved. One to three additional consolidation courses were given following surgery, and then all therapy was stopped. Eleven of 15 patients completing therapy have achieved complete remission, with seven patients remaining free of disease without maintenance therapy for 15-36 months (average, > 27 months). We conclude that patients with disseminated nonseminomatous testicular cancer should be treated for cure with intensive primary therapy. Prolonged disease-free status can be achieved without maintenance therapy, and the value of maintenance therapy needs further study.