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Annals of Oncology 2:203-211, 1991
© 1991 European Society for Medical Oncology

research-article

Original article: BOP/VIP - A new platinum-intensive chemotherapy regimen for poor prognosis germ cell tumours

C. R. Lewis1, S. D. Fosså2, G. Mead3, W. ten Bokkel Huinink4, M. J. Harding1, L. Mill1, J. Paul1, W. G. Jones5, C. J. Rodenburg6, B. Cantwell7, H. J. Keizer8, A. van Oosterom9, M. Soukop10, T. Splinter11 and S. B. Kaye1

1CRC Dept. of Medical Oncology, University of Glasgow
2Norwegian Radium Institute Oslo
3Royal South Hants Hospital Southampton
4Netherlands Cancer Institute Amsterdam
5University Department of Radiotherapy, University of Leeds
6Rotterdam Cancer Institute
7Department of Oncology, University of Newcastle
8University Hospital Leiden
9University Hospital Antwerp
10Royal Infirmary Glasgow
11Dykzigt Hospital Rotterdam

Correspondence to: Prof. S. B. Kaye, CRC Dept. of Medical Oncology, Beatson Oncology Centre, Western Infirmary Glasgow, UK

Ninety-one patients with poor prognosis non-seminomatous germ cell tumours (NSGCT) were treated with an initial intensive chemotherapy schedule. Suitable patients fulfilled one or more of the following criteria: lymph node metastases greater than 10 cm diameter; liver, brain or bone metastases; serum HCG level greater than 50 000 IU/L; and extragonadal primary tumours. Treatment consisted of 3 cycles of bleomycin, vin-cristine and cisplatin (BOP) administered at 10 day intervals, followed by 3 cycles of etoposide, ifosfamide and cisplatin (VIP) at 21 day intervals. A total of 64 patients (70%) achieved a complete remission. This comprised 46 patients who received BOP/VIP only, and 18 patients who received additional chemotherapy after BOP ATP. Of these 64 patients, 51 underwent complete surgical resection of residual masses, including 11 in whom there was evidence of teratoma with cellular atypia or non-germ cell cancer in the resected tissue. A further 9 patients had persisting unresected radiological masses in the presence of marker complete remission. The overall response rate was 80%. Currently 57 patients (63%) remain alive and free from disease progression. The median follow-up period is 90 weeks (range 24–206 weeks), with a 2 yr actuarial progression-free survival of 66% (95% c.i. 55–77%). Major toxicity was myelosuppression, occurring during the VIP arm of therapy, with a median nadir WBC of 1.1 x 109/L and median platelet count of 51 x 109/L. Other toxicity included peripheral neuropathy (WHO Grade 2 and 3 in 22%). We conclude that treatment results with the BOP/VIP schedule in this poor prognosis patient group are at least comparable with other schedules, and toxicity is manageable. A randomised prospective trial comparing BOP/VIP with standard therapy using BEP (bleomycin, etoposide, cisplatin) has now opened to assess whether an advantage can be shown for the initial intensive therapy.

chemotherapy, intensification, platinum-based, poor prognosis leratoma


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