Sequential combination chemotherapy with vinblastine-bleomycin and doxorubicin-cis-dichlorodiammineplatinum (II) in disseminated nonseminomatous testicular cancer

Forty-two patients with disseminated nonseminomatous testicular cancer were randomly entered to receive a two-armed chemotherapy regimen with mandatory crossover, consisting of either vinblastine-bleomycin or doxorubicin-cis-dichlorodiammineplatinum(II) (DDP) as initial therapy. Forty of these patients received at least four courses and were considered evaluable. Twenty-five of these patients received vinblastine-bleomycin and 15 received doxorubicin-DDP as initial treatment. The overall remission rate was 88%, with a complete remission rate of 68%. Thirty-two patients remain alive and 20 (50%) remain disease-free at 3+ to 18+ months, with a median duration of complete remissions of 9+ months. The response rate was not affected by prior chemotherapy or radiotherapy. Either treatment arm proved equally effective. However, response with doxorubicin-DDP therapy occurred in nine of 19 treatment courses when vinblastine-bleomycin therapy had failed, while response with vinblastine-bleomycin therapy occurred in only two of 11 treatment courses when doxorubicin-DDP therapy had failed. Thus, different patterns of cross-resistance between these alternative regimens may exist.