The patient was treated with six cycles of BEP, followed by four cycles of
VeIP chemotherapy.
These significantly improved outcomes compared to initial salvage VeIP can be partially explained by favorable patient selection and a small number of patients included with metastatic disease in the setting of a second gonadal primary GCT.
In the only randomized phase III study to address this question, a multi-institutional European trial (IT-94) compared four cycles of VIP or VeIP (arm A) with three such cycles followed by one cycle of high-dose carboplatin, etoposide, and cyclophosphamide with ASCT (arm B) [24].
The most common salvage therapy was TIP (n=3), followed by VeIP (n=2), etoposide (EP) (n=1), and upfront salvage high-dose chemotherapy with stem cell support (n=1).
In our cohort, TIP was most frequently used for salvage chemotherapy, while VIP (etoposide, ifosfamide and cisplatin) or VeIP regimens are commonly used in other centres, both as upfront and salvage therapy.
According to CCAR, Maryland's
VEIP requires emissions tests to be administered to 1977 and newer vehicles weight up to 26,000 pounds.
According to Envirotest, the
VEIP, which inspects 1.4 million vehicles in 19 stations and 87 lanes annually, has helped the state in reducing emissions of such volatile organic compounds as hydrocarbons and carbon monoxide by 13 tons per day and emissions of nitrogen oxide by 12 tons per day.
While other combinations have been investigated, salvage CDCT commonly consists of cisplatin plus ifosfamide and either etoposide (VIP), vinblastine (
VeIP) or paclitaxel (TIP).
VeIP (vinblastine, ifosfamide and cisplatin) and TIP (paclitaxel, ifosfamide and cisplatin) are the 2 most common, standard-dose salvage regimens.
Regimens of choice for standard dose salvage treatment include 4 cycles of either VIP, Vinblastine, ifosfamide and cisplatin (
VeIP) or Paclitaxel, ifosfamide and cisplatin (TIP).[sup.170,171,173,175]-[sup.179] With these regimens, long-term disease control can be achieved in between 15% to 60% of patients.