TREATMENT OF DISSEMINATED GERM-CELL TUMORS WITH CISPLATIN, BLEOMYCIN, AND EITHER VINBLASTINE OR ETOPOSIDE
TREATMENT OF DISSEMINATED GERM-CELL TUMORS WITH CISPLATIN, BLEOMYCIN, AND EITHER VINBLASTINE OR ETOPOSIDE
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DOI：
10.1056/nejm198706043162302
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发表时间：
1987-06-04
影响因子：
158.5
通讯作者：
LOEHRER, PJ
中科院分区：
文献类型：
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作者：
WILLIAMS, SD;BIRCH, R;LOEHRER, PJ
播散性生殖细胞肿瘤的标准化疗包括顺铂、长春碱和博莱霉素的联合，但这种方案产生大量的神经肌肉毒性。在一项随机临床试验中，261例男性播散性生殖细胞肿瘤，我们取代依托泊苷的长春碱在这个方案中的一半患者，比较两种治疗的疗效和毒性。在244名可以评估反应的患者中，74%的接受包括长春碱的方案的患者和83%的接受包括依托泊苷的方案的患者在随后的手术或不手术的情况下无病（P不显著）。在157例肿瘤体积较大的患者中，61%的患者在含长春碱的治疗方案中无瘤生存，而含依托泊苷的治疗方案中无瘤生存率为77%（P < 0.05）。接受依托泊苷治疗的患者生存率较高（P=0.048）。两种方案在骨髓抑制作用和肺毒性方面相似。然而，依托泊苷方案引起的感觉异常（P=0.02）、腹部绞痛（P=0.0008）和肌痛（P=0.00002）显著减少。我们的结论是，足叶乙甙与顺铂和博莱霉素是上级长春碱与顺铂和博莱霉素在治疗播散性生殖细胞肿瘤，因为减少神经肌肉毒性，在晚期疾病的患者，更好的疗效。
Standard chemotherapy for disseminated germ-cell tumors includes a combination of cisplatin, vinblastine, and bleomycin, but this regimen produces substantial neuromuscular toxicity. In a randomized clinical trial in 261 men with disseminated germ-cell tumors, we substituted etoposide for the vinblastine in this regimen in half the patients to compare the efficacy and toxicity of the two treatments. Among 244 patients who could be evaluated for a response, 74 percent of those receiving the regimen including vinblastine and 83 percent of those receiving the regimen including etoposide became disease-free with or without subsequent surgery (P not significant). Among the 157 patients with high tumor volume, 61 percent became disease-free on the regimen that included vinblastine, as compared with 77 percent on the regimen that included etoposide (P < 0.05). Survival among the patients who received etoposide was higher (P=0.048). The regimens were similar in terms of myelosuppressive effects and pulmonary toxicity. However, the etoposide regimen caused substantially fewer paresthesias (P=0.02), abdominal cramps (P=0.0008), and myalgias (P=0.00002). We conclude that etoposide with cisplatin and bleomycin is superior to vinblastine with cisplatin and bleomycin in the treatment of disseminated germ-cell tumors because of diminished neuromuscular toxicity and, among patients with advanced disease, better efficacy.