Paclitaxel + BEP (T-BEP) Regimen as Induction Chemotherapy in Poor Prognosis Patients With Nonseminomatous Germ Cell Tumors: A Phase II Study

• Published in: Urology (Ridgewood, N.J.) N.J.), 2011-09, Vol.78 (3), p.620-625
• Main Authors: Tryakin, A, Fedyanin, M, Kanagavel, D, Fainstein, I, Sergeev, J, Polockij, B, Matveev, V, Zakharova, T, Garin, A, Tjulandin, S
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Bleomycin - administration & dosage; Bleomycin - adverse effects; Cisplatin - administration & dosage; Cisplatin - adverse effects; Disease-Free Survival; Etoposide - administration & dosage; Etoposide - adverse effects; Humans; Male; Mediastinal Neoplasms - drug therapy; Medical sciences; Middle Aged; Neoplasms, Germ Cell and Embryonal - drug therapy; Neoplasms, Germ Cell and Embryonal - secondary; Nephrology. Urinary tract diseases; Prognosis; Testicular Neoplasms - drug therapy; Urology; Young Adult
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2011.05.005

Objectives To evaluate paclitaxel, bleomycin, etoposide, and cisplatin (T-BEP) in patients with poor-prognosis nonseminomatous germ cell tumor (NSGCT). Paclitaxel is an active treatment of nonseminomatous germ cell tumors. Methods The present study was an open-label, single-center, Phase II study. Chemotherapy-naive patients received T-BEP (paclitaxel 175 mg/m2 [day 2], cisplatin 20 mg/m2 [days 1-5], etoposide 100 mg/m2 [days 1-5], bleomycin 30 IU [days 1, 3, and 5]), and granulocyte colony-stimulating factor 300 μg (days 6-10). The number of cycles (range 4-6) was dependent on the normalization of tumor markers. Secondary resection was planned for patients with tumor marker-negative partial remission. Assessments included radiologic response, tumor markers, and safety. The primary endpoint was progression-free survival (PFS) 1 year after chemotherapy. Results Of 51 patients, 49 completed chemotherapy and were evaluable for response: 12 (25%) had a complete response, 29 (59%) were marker-negative (tumor marker normalization) and 3 (6%) were marker-positive (tumor marker decrease for ≥1 month) incomplete responders, and 5 (10%) had progressive disease. A total of 37 patients underwent secondary resection. After the treatment of 27 patients, an unplanned analysis showed inappropriate toxicity at cycle 1 (grade 3-4 infection [6 patients] resulting in 2 toxic deaths), which led to treatment modification (BEP [cycle 1], T-BEP [subsequent cycles]), with no further toxic deaths observed. Grade 3-4 adverse events included neutropenia (71%), febrile neutropenia (33%), and infection (14%). During the first year after chemotherapy, 1 patient was lost to follow-up, and 21 patients relapsed. The PFS rate at 1 year after chemotherapy was 58% (29 of 50 patients). Conclusions T-BEP did not improve PFS in patients with poor-prognosis NSGCT. The administration of T-BEP from cycle 1 resulted in excessive toxicity but was administered safely from cycle 2.