Long-term outcomes of accelerated BEP (bleomycin, etoposide, cisplatin) for advanced germ cell tumours: updated analysis of an Australian multicentre phase II trial by the Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP)

Lawrence, Nicola; Martin, Andrew; Toner, Guy C.; Stockler, Martin R.; Buizen, Luke; Thomson, Damien; Gebski, Val; Friedlander, Michael; Yeung, Alexandra; Wong, Nicole; Rosenthal, Mark; Singhal, Nimit; Kichenadasse, Ganessan; Wong, Shirley; Lewis, C. R.; Vasey, P.; Grimison, Peter

doi:10.1093/annonc/mdw313

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“…A single arm phase 2 trial of 43 patients demonstrated that the regimen is feasible and tolerable [ 12 ]. The long term efficacy data appears promising with 5 year overall survival of 92% (95% CI 54% to 99%) for patients with poor prognostic features and 94% (95% CI 63% to 99%) for patients with intermediate prognostic features [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Protocol for the P3BEP trial (ANZUP 1302): an international randomised phase 3 trial of accelerated versus standard BEP chemotherapy for adult and paediatric male and female patients with intermediate and poor-risk metastatic germ cell tumours

et al. 2018

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BackgroundBleomycin, etoposide, and cisplatin (BEP) chemotherapy administered every 3 weeks for 4 cycles remains the standard first line treatment for patients with intermediate- and poor-risk metastatic germ cell tumours (GCTs). Administering standard chemotherapy 2-weekly rather than 3-weekly, so-called ‘accelerating chemotherapy’, has improved cure rates in other cancers. An Australian multicentre phase 2 trial demonstrated this regimen is feasible and tolerable with efficacy data that appears promising. The aim of this trial is to determine if accelerated BEP is superior to standard BEP as first line chemotherapy for adult and paediatric male and female participants with intermediate and poor risk metastatic GCTs.MethodsThis is an open label, randomised, stratified, 2-arm, international multicentre, 2 stage, phase 3 clinical trial. Participants are randomised 1:1 to receive accelerated BEP or standard BEP chemotherapy. Eligible male or female participants, aged between 11 and 45 years with intermediate or poor-risk metastatic GCTs for first line chemotherapy will be enrolled from Australia, the United Kingdom and the United States. Participants will have regular follow up for at least 5 years. The primary endpoint for stage 1 of the trial (n = 150) is complete response rate and for the entire trial (n = 500) is progression free survival. Secondary endpoints include response following treatment completion (by a protocol-specific response criteria), adverse events, health-related quality of life, treatment preference, delivered dose-intensity of chemotherapy (relative to standard BEP), overall survival and associations between biomarkers (to be specified) and their correlations with clinical outcomes.DiscussionThis is the first international randomised clinical trial for intermediate and poor-risk metastatic extra-cranial GCTs involving both adult and pediatric age groups open to both males and females. It is also the largest, current randomised trial for germ cell tumours in the world. Positive results for this affordable intervention could change the global standard of care for intermediate and poor risk germ cell tumours, improve cure rates, avoid the need for toxic and costly salvage treatment, and return young adults to long, healthy and productive lives.Trial registrationACTRN 12613000496718 on 3rd May 2013 and Clinicaltrials.gov NCT02582697 on 21st October 2015.

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Section: Introductionmentioning

confidence: 99%