EXPERIENCE WITH BLEOMYCIN, ETOPOSIDE, CISPLATIN (BEP) AND ALTERNATINGCISPLATIN, CYCLOPHOSPHAMIDE, DOXORUBICIN (CISCA(II)) VINBLASTINE, BLEOMYCIN (VBIV) REGIMENS OF CHEMOTHERAPY IN POOR-RISK NONSEMINOMATOUS GERM-CELL TUMORS

Forty poor-risk patients with metastatic nonseminomatous germ cell tum ors were treated with a chemotherapy regimen that consisted of either the BEP protocol (bleomycin + etoposide + cisplatin) or the CISCA(II)/ VBIV regimen (cyclophosphamide + doxorubicin + cisplatin/vinblastine bleomycin). There was no randomization. Among 17 patients who receive d the CISCA(II)/VBIV protocol, three early deaths, four primary failur es, and 10 complete responses were observed. Two relapses and one acut e myeloid leukemia were subsequently noted. Nine (53%) of 17 patients remain free of disease 15-38 months after the end of therapy. In the g roup of patients treated with the BEP regimen, one early death, one pr imary failure, one toxic death, one partial response, and 19 complete responses were observed. There were eight relapses. Sixteen (70%) of 2 3 patients remain free of disease 26-52 months after the end of therap y. Myelosuppression and mucositis were clearly more severe with the CI SCA(II)/VBIV regimen. However, no septic death was registered, whereas one patient died of septic shock after the fourth cycle of BEP. Inves tigators of the Genitourinary Group of the French Federation of Cancer Centers have now embarked on a prospective randomized trial of BEP ve rsus CISCA(II)/VBIV in poor-risk patients.