Modified-BEP Chemotherapy in Patients With Germ-Cell Tumors Treated at a Comprehensive Cancer Center.

Abstract

OBJECTIVES:

Bleomycin, etoposide, and cisplatin (BEP) is the most common and successful chemotherapy regimen for germ-cell tumor (GCT) patients, accompanied by a bleomycin-induced dose-dependent lung toxicity in certain patients. In an attempt to reduce bleomycin-toxicity, we developed a modified-BEP (mBEP) regimen.

MATERIALS AND METHODS:

Between August 2008 and February 2018, 182 unselected mainly testicular GCT patients (39 with adjuvant purpose and 143 with curative purpose) received a tri-weekly 5-day hospitalization schedule with bleomycin 15 U intravenous (IV) push on day 1 and 10 U IV continuous infusion over 12 hours on days 1 to 3, cisplatin 20 mg/m IV, and etoposide 100 mg/m IV on days 1 to 5. Pulmonary toxicity was assessed through chest computed tomography scan and clinical monitoring.

RESULTS:

Median number of mBEP cycles was 3 (range: 1 to 4). In the curative setting, according to the International Germ Cell Cancer Collaborative Group (IGCCCG) prognostic system, 112, 21, and 9 patients had good-risk, intermediate-risk, and poor-risk class, respectively; 66 (46%) patients had complete response (CR), 67 (47%) had partial response (52 of whom became CR afterwards), 6 (4%) had stable disease (that in 3 became CR afterwards), 3 (2%) progressed, and 1 (1%) died of brain stroke. At a median follow-up of 2.67 years (interquartile range: 1.23-5.00 y), 1 and 5-year overall survival and progression-free survival were 99% and 95%, and 90% and 88%, respectively. In the entire patient population, there was grade 3/4 neutropenia in 92 patients (51%), febrile neutropenia in 11 patients (6%), grade 1/2 nausea in 74 patients (41%), and no death due to pulmonary toxicity.

CONCLUSION:

In GCT patients, our mBEP-schedule would suggest an effective treatment modality without suffering meaningful pulmonary toxicity.

• Authors: Gaetano Aurilio, Elena Verri, Samuele Frassoni, Vincenzo Bagnardi, Maria Cossu Rocca, Daniela Cullurà, Martina Milani, Roberta Mascia, Giuseppe Curigliano, Franco Orsi, Barbara A Jereczek-Fossa, Gennaro Musi, Emanuela Omodeo Salè, Ottavio De Cobelli, Franco Nolè
• Journal: American journal of clinical oncology (Am J Clin Oncol) Vol. 43 Issue 6 Pg. 381-387 (06 2020) ISSN: 1537-453X [Electronic] United States
• PMID: 32079853 (Publication Type: Journal Article)

Chemical References

• Bleomycin
• Etoposide
• Cisplatin

Topics

• Adolescent
• Adult
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, adverse effects)
• Bleomycin (administration & dosage, adverse effects)
• Cancer Care Facilities
• Cisplatin (administration & dosage, adverse effects)
• Drug Administration Schedule
• Etoposide (administration & dosage, adverse effects)
• Humans
• Lung Diseases (chemically induced, prevention & control)
• Male
• Neoplasms, Germ Cell and Embryonal (drug therapy)
• Retrospective Studies
• Young Adult