VAB-6 combination chemotherapy in disseminated cancer of the testis

Twenty-nine men with stage III or unresectable stage II malignant germ cell tumors and no previous chemotherapy received treatments with the VAB-6 protocol. The VAB-6 regimen is a 1-year program beginning with three successive inductions at 3-to-4-week intervals: day 1--cyclophosphamide, 600 mg/m of body surface area intravenously, bleomycin, 30 mg intravenously, dactinomycin, 1 mg/m2 intravenously, and vinblastine, 4 mg/m2 intravenously; days 1 through 3--bleomycin, 20 mg/m2 . d by continuous infusion; and day 4--cisplatin, 120 mg/m2 intravenously. Bleomycin is omitted from the third induction. One month after the third induction, any residual disease is resected. If the resected specimen contains malignant tissue, an additional two inductions are given before maintenance with vinblastine, 6 mg/m2 intravenously, and dactinomycin, 1 mg/m2 intravenously, every 3 weeks. Of 25 patients with evaluable records, 23 achieved complete remission, and 21 remain in complete remission (median follow-up, more than 16 months). Myelosuppression is the major toxicity. With VAB-6 response rate is high, and treatment is short and better tolerated than with previous VAB protocols.