The role of ifosfamide plus cisplatin-based chemotherapy as salvage therapy for patients with refractory germ cell tumors.
 A prospective study of four cycles of etoposide with ifosfamide and cisplatin (VIP) chemotherapy was conducted in 42 germ cell tumor (GCT) patients who were refractory to cisplatin with etoposide/vinblastine-based therapy.
 Forty patients were evaluable for response.
 Ten patients (25%) had a complete response: seven to chemotherapy alone and an additional three patients after surgical resection of viable GCT.
 With a median follow-up of 15 months, four complete responders relapsed, and six patients (15%) remain in remission.
 Hematologic and nephrotoxicity were moderately severe.
 Durable complete responses with VIP as second salvage were achieved and suggests that ifosfamide adds efficacy to standard first-salvage therapy.
 The observed nephrotoxicity and myelotoxicity are considerations in the design of ifosfamide-cisplatin-based regimens.
 Hematopoietic growth factors may be useful in ameliorating myelotoxicity.
 The early use of ifosfamide-based chemotherapy may reduce the nephrotoxicity exacerbated by prior cisplatin.
 A trial of VIP as first salvage after a relapse from a complete response to platinum-based induction therapy is warranted.
 The modest proportion of patients who achieve a durable remission to VIP as second salvage emphasizes the need for more efficacious salvage therapy for patients who do not achieve a durable complete response.
