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

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• 作者：A. Tryakin  ; ;   ; ^{atryakin@mail.ru} ; M. Fedyanin ; D. Kanagavel ; I. Fainstein ; J. Sergeev ; B. Polockij ; V. Matveev ; T. Zakharova ; A. Garin ; S. Tjulandin
• 刊名：Urology
• 出版年：2011
• 出版时间：September 2011
• 年：2011
• 卷：78
• 期：3
• 页码：620-625
• 全文大小：305 K

文摘

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 ¦Ìg (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 ? 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.