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. 1996 Sep;74(6):947–950. doi: 10.1038/bjc.1996.462

Treatment of advanced seminoma with cyclophosphamide, vincristine and carboplatin on an outpatient basis.

S Sleijfer 1, P H Willemse 1, E G de Vries 1, W T van der Graaf 1, H Schraffordt Koops 1, N H Mulder 1
PMCID: PMC2074753  PMID: 8826863

Abstract

This study describes the efficacy and toxicity of a combination regimen consisting of cyclophosphamide, vincristine (oncovin) and carboplatin (COC) for advanced seminoma on an outpatient basis. Twenty-seven patients (mean age 43 years, range 28-63 years) were classified as stage IIC (n = 5), stage IID (n = 12), stage III (n = 9) or stage IV (n = 1). Six had been treated with prior radiotherapy; elevated beta-HCG and elevated LDH serum levels were observed in 15 and 25 patients respectively. Patients were treated with four cycles of 750 mg m-2 cyclophosphamide intravenously (i.v.), 1.4 mg m-2 vincristine i.v. (maximum 2 mg) and carboplatin adjusted to creatinine clearance. Cycles were given at 3 week intervals. The median dose of carboplatin administered was 400 mg m-2 (range 300-450 mg m-2). Six patients [22%; 95% confidence interval (CI), 6-38%] achieved a complete response (CR), 19 (70%; 95% CI, 51-88%) a partial response and two (8%; 95% CI, 0 18%) showed only a response in tumour markers but not a reduction of retroperitoneal mass (NR). Post-chemotherapeutic masses were not removed surgically or irradiated. After a median follow-up of 26 months (range 5-69 months), two patients have died, one from cardiac arrest 2 years after achieving CR, the other with relapsed seminoma 5 months after therapy. None of the other patients relapsed. Main toxicity was haematological, with 22 patients (81%) experiencing thrombocytopenia WHO grade III/IV and 27 (100%) leucocytopenia WHO grade III/IV, requiring dose reduction in five patients. Seven patients experienced granulocytopenic fever. Non-haematological toxicity was rare. Peripheral neuropathy grade I was observed in four patients and grade III in one. Haemorrhagic cystitis occurred once. In conclusion, despite considerable haematological toxicity, COC is feasible on an outpatient basis, even after prior radiotherapy, and is an effective regimen for advanced seminoma with only 1/27 treatment failures after a median follow-up of 26 months.

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Selected References

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  1. Amato R. J., Ellerhorst J., Banks M., Logothetis C. J. Carboplatin and ifosfamide and selective consolidation in advanced seminoma. Eur J Cancer. 1995 Dec;31A(13-14):2223–2228. doi: 10.1016/0959-8049(95)00341-x. [DOI] [PubMed] [Google Scholar]
  2. Biesma B., Willemse P. H., Mulder N. H., Sleijfer D. T., Gietema J. A., Mull R., Limburg P. C., Bouma J., Vellenga E., de Vries E. G. Effects of interleukin-3 after chemotherapy for advanced ovarian cancer. Blood. 1992 Sep 1;80(5):1141–1148. [PubMed] [Google Scholar]
  3. Calvert A. H., Harland S. J., Newell D. R., Siddik Z. H., Harrap K. R. Phase I studies with carboplatin at the Royal Marsden Hospital. Cancer Treat Rev. 1985 Sep;12 (Suppl A):51–57. doi: 10.1016/0305-7372(85)90018-0. [DOI] [PubMed] [Google Scholar]
  4. Fosså S. D., Aass N., Kaalhus O. Radiotherapy for testicular seminoma stage I: treatment results and long-term post-irradiation morbidity in 365 patients. Int J Radiat Oncol Biol Phys. 1989 Feb;16(2):383–388. doi: 10.1016/0360-3016(89)90334-9. [DOI] [PubMed] [Google Scholar]
  5. Fosså S. D., Borge L., Aass N., Johannessen N. B., Stenwig A. E., Kaalhus O. The treatment of advanced metastatic seminoma: experience in 55 cases. J Clin Oncol. 1987 Jul;5(7):1071–1077. doi: 10.1200/JCO.1987.5.7.1071. [DOI] [PubMed] [Google Scholar]
  6. Fosså S. D., Droz J. P., Stoter G., Kaye S. B., Vermeylen K., Sylvester R. Cisplatin, vincristine and ifosphamide combination chemotherapy of metastatic seminoma: results of EORTC trial 30874. EORTC GU Group. Br J Cancer. 1995 Mar;71(3):619–624. doi: 10.1038/bjc.1995.121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Gietema J. A., Willemse P. H., Mulder N. H., Oldhoff J., de Vries E. G., Sleijfer D. T. Alternating cycles of PVB and BEP in the treatment of patients with advanced seminoma. Eur J Cancer. 1991;27(11):1376–1379. doi: 10.1016/0277-5379(91)90013-4. [DOI] [PubMed] [Google Scholar]
  8. Horwich A., Dearnaley D. P., A'Hern R., Mason M., Thomas G., Jay G., Nicholls J. The activity of single-agent carboplatin in advanced seminoma. Eur J Cancer. 1992;28A(8-9):1307–1310. doi: 10.1016/0959-8049(92)90505-v. [DOI] [PubMed] [Google Scholar]
  9. Horwich A., Dearnaley D. P., Duchesne G. M., Williams M., Brada M., Peckham M. J. Simple nontoxic treatment of advanced metastatic seminoma with carboplatin. J Clin Oncol. 1989 Aug;7(8):1150–1156. doi: 10.1200/JCO.1989.7.8.1150. [DOI] [PubMed] [Google Scholar]
  10. Kamen B. A., Frenkel E., Colvin O. M. Ifosfamide: should the honeymoon be over? J Clin Oncol. 1995 Feb;13(2):307–309. doi: 10.1200/JCO.1995.13.2.307. [DOI] [PubMed] [Google Scholar]
  11. Loehrer P. J., Sr, Birch R., Williams S. D., Greco F. A., Einhorn L. H. Chemotherapy of metastatic seminoma: the Southeastern Cancer Study Group experience. J Clin Oncol. 1987 Aug;5(8):1212–1220. doi: 10.1200/JCO.1987.5.8.1212. [DOI] [PubMed] [Google Scholar]
  12. Logothetis C. J., Samuels M. L., Ogden S. L., Dexeus F. H., Chong C. D. Cyclophosphamide and sequential cisplatin for advanced seminoma: long-term followup in 52 patients. J Urol. 1987 Oct;138(4):789–794. doi: 10.1016/s0022-5347(17)43376-3. [DOI] [PubMed] [Google Scholar]
  13. Mencel P. J., Motzer R. J., Mazumdar M., Vlamis V., Bajorin D. F., Bosl G. J. Advanced seminoma: treatment results, survival, and prognostic factors in 142 patients. J Clin Oncol. 1994 Jan;12(1):120–126. doi: 10.1200/JCO.1994.12.1.120. [DOI] [PubMed] [Google Scholar]
  14. Motzer R., Bosl G., Heelan R., Fair W., Whitmore W., Sogani P., Herr H., Morse M. Residual mass: an indication for further therapy in patients with advanced seminoma following systemic chemotherapy. J Clin Oncol. 1987 Jul;5(7):1064–1070. doi: 10.1200/JCO.1987.5.7.1064. [DOI] [PubMed] [Google Scholar]
  15. Peckham M. J., McElwain T. J., Barrett A., Hendry W. F. Combined management of malignant teratoma of the testis. Lancet. 1979 Aug 11;2(8137):267–270. doi: 10.1016/s0140-6736(79)90288-5. [DOI] [PubMed] [Google Scholar]
  16. SNYDER W., RODENSKY P., LIEBERMAN B. REGRESSION, RELAPSE, AND REGRESSION OF METASTATIC SEMINOMA BY CYCLOPHOSPHAMIDE (NSC-26271). Cancer Chemother Rep. 1964 Sep;41:37–40. [PubMed] [Google Scholar]
  17. Schmoll H. J., Harstrick A., Bokemeyer C., Dieckmann K. P., Clemm C., Berdel W. E., Souchon R., Schöber C., Wilke H., Poliwoda H. Single-agent carboplatinum for advanced seminoma. A phase II study. Cancer. 1993 Jul 1;72(1):237–243. doi: 10.1002/1097-0142(19930701)72:1<237::aid-cncr2820720142>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]
  18. Schultz S. M., Einhorn L. H., Conces D. J., Jr, Williams S. D., Loehrer P. J. Management of postchemotherapy residual mass in patients with advanced seminoma: Indiana University experience. J Clin Oncol. 1989 Oct;7(10):1497–1503. doi: 10.1200/JCO.1989.7.10.1497. [DOI] [PubMed] [Google Scholar]
  19. Thomas G. M., Rider W. D., Dembo A. J., Cummings B. J., Gospodarowicz M., Hawkins N. V., Herman J. G., Keen C. W. Seminoma of the testis: results of treatment and patterns of failure after radiation therapy. Int J Radiat Oncol Biol Phys. 1982 Feb;8(2):165–174. doi: 10.1016/0360-3016(82)90509-0. [DOI] [PubMed] [Google Scholar]
  20. Veldhuis G. J., Willemse P. H., van Gameren M. M., Aalders J. G., Mulder N. H., Mull B., Biesma B., de Vries E. G. Recombinant human interleukin-3 to dose-intensify carboplatin and cyclophosphamide chemotherapy in epithelial ovarian cancer: a phase I trial. J Clin Oncol. 1995 Mar;13(3):733–740. doi: 10.1200/JCO.1995.13.3.733. [DOI] [PubMed] [Google Scholar]
  21. Wettlaufer J. N. The management of advanced seminoma. Semin Urol. 1984 Nov;2(4):257–263. [PubMed] [Google Scholar]
  22. Williams S. D., Roth B. J. Chemotherapy of testis cancer: a review. Int J Radiat Oncol Biol Phys. 1992;22(1):213–217. doi: 10.1016/0360-3016(92)91002-5. [DOI] [PubMed] [Google Scholar]
  23. de Vries E. G., Biesma B., Willemse P. H., Mulder N. H., Stern A. C., Aalders J. G., Vellenga E. A double-blind placebo-controlled study with granulocyte-macrophage colony-stimulating factor during chemotherapy for ovarian carcinoma. Cancer Res. 1991 Jan 1;51(1):116–122. [PubMed] [Google Scholar]

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