BOMP EPI intensive alternating chemotherapy for IGCCC poor-prognosis germ-cell tumors: The Spanish Germ-Cell Cancer Group experience (GG)

Background: Patients with poor-prognosis germ-cell tumors according to the IGCCC have a poor long-term survival. This study evaluates the efficacy and toxicity of the intensive alternating chemotherapy regimen BOMP/EPI in the se patients. Patients and methods: Patients with IGCCC poor-prognosis germ-cell tumors t reated at 13 centres were studied. Treatment consisted of bleomycin 30 mg, vincristine 2 mg, methotrexate 300 mg/m(2) and cisplatin 100 mg/m(2) (BOMP) , alternating after a 14-day interval with etoposide 120 mg/m(2) day 1-4, i fosfamide 1.3 g/m(2) day 1-4 and cisplatin 25 mg/m(2) day 1-4 (EPI). POMP w as administered 21 days after the EPI. Bleomycin was administered weekly pe r 12 weeks. Results: Thirty-eight patients were treated. The median number of cycles ad ministered was 7 (1-10 cycles). Eighteen patients achieved complete respons es with chemotherapy alone (12 had necrosis and 2 mature teratoma at postch emotherapy resection), and four achieved complete responses with chemothera py and surgical resection of viable cancer. Thus, an overall favorable resp onse was achieved in 22 patients (60%). Four additional patients had marker -negative non-resected residual masses. Eleven patients were consider-ed tr eatment failures, including one who died early and another who succumbed to granulocytopenic sepsis and renal failure. Hematologic toxicity was the mo st common, with 26 patients (70%) having grade 4 granulocytopenia. After a median follow-up of 41 months, the actuarial two-year overall survival and progression-free survival were 64% and 58%, respectively. Conclusion: BOMP/EPI is active in poor-prognosis germ-cell tumors according to the IGCCC criteria. The results obtained compare favorably with those e xpected with conventional chemotherapy, and justify further studies.