This study confirms the safety of surveillance as a method of management and identifies a group of patients with a high risk of relapse. A prospective phase II study has been initiated to determine whether two courses of platinum-based adjuvant chemotherapy will prevent relapse in these high-risk patients.
We conclude that three cycles of BEP, with etoposide at 500 mg/m(2), is sufficient therapy in good-prognosis germ cell cancer and that the administration of the chemotherapy in 3 days has no detrimental effect on the effectiveness of the BEP regimen.
in the 298 allocated to CEB (log-rank x 2 = 2 6 .9 ; P < .001), which led to failure-free rates at 1 y e a r of 91% (95% confidence interval [Cl], 88% to 94%) and 77% (95% Cl, 72% to 82%), respectively. There w ere 10 deaths in patients allocated to BEP and 2 7 in patients allocated to CEB (log-rank x* = 8.77; P = .0 0 3 ), which led to 3-year survival rates of 97% (95% Cl, 95% to 99%) and 90% (95% Cl, 86% to 94% ), respectively.Conclusion: With these drug doses and schedules, combination chemotherapy based on carboplatin was inferior to that based on cisplatin. This BEP regimen that contains moderate doses of etoposide and bleomycin is effective in the treatment of patients with good-prognosis metastatic nonseminoma.
Because of the excess of acute GI toxicity and the increased risk of tinnitus after the 3-day regimen, we recommend the 5-day regimen if four cycles of BEP are planned. If only three cycles are to be given, then the 3-day regimen is acceptable, even given the increased risk of nausea/vomiting at 3 months.
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