CISPLATIN-ETOPOSIDE AND CARBOPLATIN-ETOPOSIDE INDUCTION CHEMOTHERAPY FOR GOOD-RISK PATIENTS WITH GERM-CELL TUMORS

Background: In an attempt to reduce the toxicity of chemotherapy in go od-risk testicular cancer patients the two drug combinations, cisplati n plus etoposide (EP) and carboplatin plus etoposide (EC), have been c ompared. Methods: Good risk was defined according to the MSKCC and IU criteria. 39 Patients have been treated with EP (cisplatin 20 mg/m2 i. v. and etoposide 100 mg/m2 i.v. on days 1 to 5), and 23 patients recei ved EC (carboplatin 350 mg/m2 on day 1 and etoposide 100 mg/m2 on days 1 to 5). Four cycles of chemotherapy were given at 21- and 28-day int ervals, respectively, with delays of up to 7 days in istances of leuko cyte counts less than 3.0 x 10(9)/l or platelet counts less than 100 x 10(9)/l. Results: In the EP group 34 (87%) of 39 patients achieved CR (26 with chemotherapy alone, 8 with additional surgery). After a medi an follow-up of 26 (12-58) months 3 (9%) patients relapsed from CR. Cu rrently 38 patients are alive, and 37 (94%) are NED. In the EC group 2 0 (87%) of 23 patients achieved CR (15 with chemotherapy alone and 5 w ith additional surgery). After a median follow-up of 45 (26-57) months 6 (30%) patients relapsed from CR. Currently 19 patients are alive an d 17 (74%) are NED. There was no difference in survival between the tw o groups (p = 0.13), but in the EC group the relapse rate was higher ( p = 0.052) and the proportion of patients with NED was lower (p = 0.03 ) in comparison with EP. Toxicity in both groups was mild and similar, but 3 EP-treated patients presented hair loss. Conclusions: The study suggests that carboplatin-etoposide combination therapy is inferior t o cisplatin-etoposide in patients with good-risk germ cell tumors.