INTRODUCTION: Induction chemotherapy for International Germ Cell Cancer Collaborative Group (IGCCCG) good-risk metastatic testicular cancer includes either 3 cycles of bleomycin, etoposide, and cisplatin (BEP) or 4 cycles of etoposide and cisplatin (EP).
We sought to examine differences in active cancer in the retroperitoneum (RP) between patients receiving BEPx3 compared to EP x4.
METHODS: The Indiana University Testis Cancer database was queried to identify IGCCCG good risk patients who received either BEPx3 or EPx4 induction chemotherapy prior to PC-RPLND. The primary outcome of interest was RP histology. The association between use of bleomycin in the induction regimen with active cancer in the RP was tested using a propensity score-adjusted analysis.
RESULTS: One hundred seventy-nine men (79%) received BEPx3 while 47 (21%) received EPx4. The median age of the BEP group was 27 years (range: 15-50) compared to 30 years (range: 18-71) in the EP group. The incidence of active cancer in the RP specimen at PC-RPLND was significantly higher in the EPx4 group compared to the BEPx3 group (31.9% vs. 7.8%, p< 0.01). This significant difference between the BEP and EP groups remained in the propensity-adjusted analysis (22.9% vs. 7.8%, p=0.015).
CONCLUSION: There was a higher incidence of active cancer in the RP specimen in good risk patients who receive 4 cycles of induction EP chemotherapy compared to men receiving 3 cycles of BEP in this retrospective analysis. The overall burden of treatment may be higher for men receiving EP x4 for induction chemotherapy.
Written by:
Cary KC, Pedrosa JA, Kaimakliotis HZ, Masterson TA, Einhorn LH, Foster RS. Are you the author?
Indiana University School of Medicine Department of Urology, Indiana University Melvin and Bren Simon Cancer Center.
Reference: J Urol. 2014 Sep 21. pii: S0022-5347(14)04487-5.
doi: 10.1016/j.juro.2014.09.090
PubMed Abstract
PMID: 25254937