The treatment of advanced testicular carcinoma with high dose chemotherapy and autologous marrow support

Abstract

Thirteen patients with disseminated nonseminomatous germ cell carcinoma, failing to respond to extensive prior chemotherapy including cis-platinum, were treated with high dose chemotherapy. Cyclophosphamide (4.5g/m²) and epipodophyllotoxin (VP-16) (600 mg/m²) were given followed by autologous bone marrow transplantation. In some cases 1,3 bis (β-chloroethyl)-1-nitrosourea (BCNU), adriamycin or platinum were also administered. Of 10 patients evaluable for response 9 responded; 4 patients achieved a complete remission and 3 a partial remission. Median response duration was 15 weeks (range 4 to 20+ weeks). Four patients died from treatment-related infections; 2 of whom entered the program already with fever and 3 of whom died after hematopoietic recovery. Major toxicities were bacterial and fungal infections. In patients treated with cyclophosphamide and VP-16 only, no fever was seen in 3 out of 9 courses. Granulocyte transfusion was given in only 1 of 9 courses. Neutrophils recovered to greater than 1.5 × 10⁹/liter by day 18–35 (median 23) and platelets greater than 100 × 10⁹/liter by day 16 to 42+ (median 21). Further experience with high dose cyclophosphamide and VP-16 followed by autologous bone marrow transplantation is needed to evaluate its value in the management of patients with disseminated nonseminomatous germ cell tumor failing front line conventional chemotherapy.