Cisplatin-based chemotherapy in advanced seminoma: the Institut Gustave Roussy experience.

The aim of this study was to report the results of cisplatin-based combination chemotherapy for patients with pure seminomatous tumours. 72 patients with advanced seminoma were treated with various cisplatin-based chemotherapy regimens. 61 (85%) patients achieved a sustained durable response. 11 relapses were observed with a median time to failure of 6 months. Overall, 60 (83%) of the 72 patients remain alive and free of disease after a median follow-up of 64 months. Initial clinical (age, site of primary, prior radiotherapy, extent of disease) and biological (serum human chorionic gonadotrophin levels, serum lactic dehydrogenase levels, p53 immunostaining) features which could be of predictive value for survival, were analysed in a univariate analysis. No variable retained statistical significance. High cure rates are expected after chemotherapy with standard cisplatin-based combinations in advanced seminoma. Renewed efforts are required to identify markers of chemosensitivity.

[Value of mono-antibiotic therapy using piperacillin associated with sulbactam and possibly followed by vancomycin in febrile neutropenia in solid tumors]. / Intérêt d'une monoantibiothérapie par pipéracilline associée au sulbactam et suivie éventuellement par la vancomycine dans les neutropénies fébriles des tumeurs solides.

We evaluated the efficacy and safety of a monotherapy by piperacillin and sulbactam potentially associated to vancomycin as an empiric antimicrobial therapy in febrile neutropenic patients treated with nephrotoxic chemotherapy for solid tumors. Twenty-three patients were treated during 32 episodes with piperacillin 4 g i.v. every 8 hours and sulbactam 1 g IV every 8 hours. If the patient remained febrile after 48 hours, 1 g of vancomycin i.v. was added every 12 hours as indicated by our study design. The mean duration of neutropenia was 5.5 days (2-13 days). In ten episodes, the granulocyte nadir was < 100/mm3. Infection was microbiologically documented in seven episodes (22%) with six Gram negative bacilli and 3 Gram positive cocci. There were 19 apyrexia with piperacillin and sulbactam (59%) and further seven were resolved by the addition of vancomycin (total success: 81%). Failure was observed in six episodes consecutive to germ resistance (one episode), clinical deterioration (one episode), relapsing fever related to Pseudomonas infection (one episode), persistent fever despite withdrawal of neutropenia and no microbiological documentation (two episodes) and protocol violation (one episode). Neither septic death nor toxicity were observed. We conclude that this empirical treatment is active and safe in short period febrile neutropenic episodes in patients heavily treated with nephrotoxic chemotherapy for solid tumors.