VAB‐6 combination chemotherapy without maintenance in treatment of disseminated cancer of the testis

Thirty-six men with Stage III or bulky Stage II malignant germ cell tumors of the testis who received no prior chemotherapy were treated with the VAB-6 protocol without maintenance and 34 were evaluable. The VAB-6 regimen is a 3-4 month program beginning with successive inductions at 3-4 week intervals: day 1, cyclophosphamide 600 mg/m2 of body surface, bleomycin 30 mg, vinblastine 4 mg/m2 and dactinomycin 1 mg/m2 intravenously; days 1-3, bleomycin 20 mg/m2/day X 3 by continuous 24-hour intravenous infusion; and day 4, cis-platinum 120 mg/m2 intravenously. Complete responders receive a fourth induction and are followed thereafter without further chemotherapy. Incomplete responders have resection of residual disease one month after the third induction. If the resected specimen contains malignant tissue, an additional two inductions are given. Thirty-one of 34 (91%) evaluable patients achieved complete remission and 28 remain in complete remission with median follow up of 24+ months. Chemotherapy alone was most effective in patients with minimal metastatic disease, with no teratoma in primary tumor, and with pure seminoma. Patients with advanced metastatic deposits or with teratoma in the primary tumor frequently required combined chemotherapy and surgery to achieve disease free status. Myelosuppression was the principal potentially serious toxicity. With effective induction, maintenance chemotherapy is not necessary.