Germ cell tumors (II): VAB II in metastatic testicular cancer

Between June 1974 and January 1976, 50 patients with metastatic non-seminometous testicular carcinoma were treated with the VAB II protocol. The induction phase consisted of vinblastine (0.4 mg/kg) and actinomycin D (0.02 mg/kg) on day 1. Bleomycin (0.5 mg/kg) was given by continuous infusion for 7 days, and cis-diammine-dichloroplatinum (II) (DDP) (1 mg/kg) was given on day 8. A weekly maintenance of vinblastine and bleomycin, with actinomycin D and DDP on a rotating schedule was given followed by vinblastine, actinomycin D and chlorambucil every 3--4 weeks. Therapy was discontinued after 30--36 months of treatment in the face of continued remission. The response rate was 50% CR, 34% PR with 60% CR and 36% PR in previously untreated patients. Second-look surgery and excision of residual lesions was performed in selected cases. Alopecia, mucositis, nausea, and vomiting were universal. One patient died in the postsurgical period of toxicity from the combination of bleomycin and high concentrations of oxygen. There were seven instances of allergic reactions to DDP. Eleven of 25 complete responders and 4 partial or minor responders who underwent excision of stable disease remain alive from 19 to 35 months following start of therapy, 12 of them without evidence of disease.