Friday, August 1, 2014

Classic Manuscript in Urology: Einhorn and Donohue. Journal of Urology, 1977.

Lawrence Einhorn, MD
In the 1960's, metastatic testicular cancer was a death sentence - with a greater than 90% mortality within 1 year of diagnosis.  In 1965,  cisplatinum  chemotherapy was discovered by Dr. Rosenberg at Michigan State University.[47] The drug was tried in testicular cancer in 1971, with a number of complete responses to treatment but with terrible side effects including permanent renal failure.[49]  Shortly thereafter, Drs. Einhorn and Donahue added cisplatinum to the combination of vinblastine and bleomycin, a chemotherapy with some known efficacy in testicular cancer.  The results were astounding - the cure rate went from 10% to 70% and the treatment of testicular cancer was changed forever.

Einhorn LH, Donohue JP.  Improved chemotherapy in disseminated testicular cancer.  J Urol. 1977 Jan;117(1):65-9.
Journal of Urology.

In this manuscript, Drs. Einhorn and Donohue describe their initial experience with a platinum-based regimen for the treatment of metastatic testis cancer.  Twenty-seven patients received either a regimen of adriamycin, bleomycin and vincristine or platinum, vinblastine and bleomycin (PVB).  The patients receiving PVB had an outstanding response with 16 of 21 (76%) achieving a complete response (no visible cancer), 4 (20%) with a partial response and only 1 with no response.  Considering all patients treated by Dr. Einhorn during this time period, complete remission was achieved with PVB chemotherapy alone in 85% and 93% with additional surgery.

Unfortunately, the response was not durable in all patients. In the manuscript, Dr. Einhorn speculates in the discussion,
"Although we do not have long-term followup data on any of our patients treated with [PVB], it seems quite reasonable to expect at least 50 percent of our patients in complete remission will have cures..."
In fact, the durable cure rate was closer to 70% -- a logarithmic increase in the survival for men with advanced germ cell tumors!

Another important point from this paper was that the "Einhorn Regimen" involved more than just PVB.  By hydrating patients with copious fluids, Dr. Einhorn mitigated many of the toxicities, including nephrotoxicity.  Shortly after this publication, Dr. Einhorn would work to design, implement and add antiemetics to the regimen.  The results were so impressive the FDA (Food & Drug Administration) approved the "Einhorn Regimen" for advanced testicular cancer without any further studies.

Take home: Metastatic testis cancer was fatal in nearly all patients before this study.  Careful selection of chemotherapeutic agents based on mechanistic principles changed the paradigm for testis cancer (and many other malignancies).  Attention to side effect profiles and adjuvant therapies to mitigate side effects can improve outcomes in patients receiving cytotoxic chemotherapy.

Classic Manuscripts in Urology will be posted on this blog on regular basis.  These articles are meant to highlight the achievements of our predecessors, recognize the work from which we build our careers and stimulate new conversations and discussion on a variety of urological topics.  Please feel free to comment on this manuscript, help point out its strengths and weaknesses, or suggest a new manuscript and topic. 


  1. Thanks for sharing the information about the Einhorn and Donohue Journal of Urology.
    cure ed,male dysfunction treatment,Infertility Treatment

  2. Thank you for sharing. You have broadened my knowledge. Keep up the good work!

    Nursing Jobs

  3. WHAT A GREAT MIRACLE THAT I HAVE EVER SEE IN MY LIFE. My names are Clara David I’m a citizen of USA, My younger sister was sicking of
    breast cancer and her name is Sandra David I and my family have taking her
    to all kind of hospital in USA still yet no good result. I decided to go to
    the internet and search for cancer cure so that was how I find a lady
    called peter Lizzy she was testifies to the world about the goodness of a
    herbal man who has the roots and herbs to cure all kind of disease and the
    herbal man email was there. So I decided to contact the herbal man @herbalist_sakura for my younger sister help to cure her breast cancer. I contacted him and told him
    my problem he told me that I should not worry that my sister cancer will be
    cure, he told me that there is a medicine that he is going to give me that
    I will cook it and give it to my sister to drink for one week, so I ask how
    can I receive the cure that I am in USA, he told me
    That I will pay for the delivery service. The courier service can
    transport it to me so he told me the amount I will pay, so my dad paid for
    the delivery fee. two days later I receive the cure from the courier
    service so I used it as the herbal man instructed me to, before the week
    complete my sister cancer was healed and it was like a dream to me not
    knowing that it was physical I and my family were very happy about the
    miracle of Doctor so my dad wanted to pay him 5 million us dollars the
    herbal man did not accept the offer from my dad, but I don't know why he
    didn't accept the offer, he only say that I should tell the world about him
    and his miracle he perform so am now here to tell the world about him if
    you or your relative is having any kind of disease that you can't get from
    the hospital please contact or whats app him
    +2348110114739  you can follow him up on Instagram @herbalist_sakura for the cure, he will help you out with the
    problem. And if you need more information about the doctor you can mail me 

  4. In fact, the durable cure rate was closer to 70% -- a logarithmic increase in the survival for men with advanced germ cell tumors!
    khaadi online stitched
    khaadi 3 piece suit stitched