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Intensive Induction Chemotherapy With CBOP/BEP in Patients With Poor Prognosis Germ Cell Tumors

J.A. Christian, R.A. Huddart, A. Norman, M. Mason, S. Fossa, N. Aass, E.J. Nicholl, D.P. Dearnaley, A. Horwich

From the Academic Department of Radiotherapy and Oncology, Royal Marsden Hospital, Sutton, Surrey, and Velindre Hospital, Cardiff, United Kingdom; and Det Norske Radium Hospital, Montebello, Oslo, Norway.

Address reprint requests to J.A. Christian, MD, Academic Department of Radiotherapy and Oncology, Royal Marsden Hospital, Downs Rd, Sutton, Surrey SM2 5PT, United Kingdom; email: j.christian{at}icr.ac.uk.

Purpose: Despite a high cure rate in patients with testicular cancer, there remain patients in the poor prognosis group who have a less favorable outcome. Intensive induction chemotherapy using a regimen consisting of carboplatin, bleomycin, vincristine, and cisplatin, followed by bleomycin, etoposide, and cisplatin (CBOP/BEP), developed at the Royal Marsden Hospital, is designed to overcome the rapid proliferation seen in germ cell tumors. This study assesses the outcome of patients with poor-prognosis nonseminomatous germ cell tumors (NSGCT) treated with CBOP/BEP.

Patients and Methods: Patients with NSGCT from three centers, classified as poor prognosis according to International Germ Cell Classification Consensus Group criteria, were treated with CBOP/BEP regimen during the period from 1989 to 2000. Data on treatment toxicity, relapse-free survival (RFS), and overall survival (OS) were collected prospectively on a hospital database.

Results: Fifty-four male patients with poor prognosis NSGCT were treated with CBOP/BEP. The RFS at 3 and 5 years for all patients was 83.2% (95% confidence interval [CI], 68.8% to 91.3%). After a median follow-up of 4 years, the OS of the 54 patients was 91.5% (95% CI, 78.6% to 96.8%) at 3 years and 87.6% (95% CI, 71.3% to 94.9%) at 5 years. Three-year OS in patients with a primary mediastinal germ cell tumor was 77.1% (95% CI, 34.5% to 93.9%) compared with 95.4% (95% CI, 82.8% to 98.8%) in patients with a testicular primary tumor (P = .24).

Conclusion: The results reported here compare favorably with the historical results of alternative regimens used in the management of poor-prognosis NSGCT. We suggest a phase III trial to confirm our findings.

Supported by the Institute of Cancer Research and Cancer Research UK (grant no. C46/A2131), London; and Bob Champion Cancer Trust, Surrey, UK.

This work was undertaken in The Royal Marsden National Health Service (NHS) Trust, which received a proportion of its funding from the NHS Executive. The views expressed in this publication are those of the authors and not necessarily those of the NHS Executive.

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