Bleomycin, Etoposide and Cisplatinum (BEP) Chemotherapy for Metastatic Germ Cell Tumours: Treatment Outcomes at UKM Medical Centre, Malaysia

Introduction: Although bleomycin/etoposide/cisplatinum (BEP) chemotherapy is established as the standardtreatment for germ cell tumours, it requires significant experience in administration and toxicity managementto maintain optimal dose intensity. A retrospective review of 30 patients was conducted at UKMMC to studytreatment outcomes. Methods & Materials: Patients with GCTs and treated with at least two cycles of BEPchemotherapy between January 2003 and Oct 2009 were eligible for this study. Patients received 4-6 cycles ofbleomycin 30,000IU IV D1, D8 & D15 and either etoposide 100mg/m2 IV D1- D5 and cisplatin 20mg/m2 IV D1-D5 (5 day BEP regimen) or etoposide 165mg/m2 D1- D3 and cisplatin 50mg/m2 D1-3 (3 day BEP regimen)every three weeks per cycle. All patients received prophylactic granulocyte colony-stimulating factor (GCSF)from days 6 to 10 of each cycle. The overall response rates, 2 year progression-free survival and overall survivalof the whole cohort were assessed.
Results: Thirty patients fulfilled the inclusion criteria. Non-seminomatousGCTs comprised 93.3% of cases and gonadal and mediastinal primary sites were the most common. Sixty percentwere classified as IGCCCG poor risk disease. Median follow-up was 26.6 months. The overall response rate(CR+PR) was 70%. The two year PFS and OS were 70% and 66%. There was a significant difference in termsof the overall response rate (85% vs 40%, p = 0.03) and in PFS (94.7% vs 50%, p = 0.003) between gonadaland extragonadal primary sites.
Conclusion: It is possible to achieve outcomes similar to those in internationalclinical trials with close monitoring and good supportive care of patients undergoing BEP chemotherapy. Thereis a strong argument for patients with IGCCCG poor prognosis disease to be treated in specialist tertiary centresto optimize treatment outcomes.