BOMP EPI intensive alternating chemotherapy for IGCCC poor-prognosis germ-cell tumors:: The Spanish Germ-Cell Cancer Group experience (GG)

Background: Patients with poor-prognosis germ-cell tumors according to the IGCCC have a poor long-term survival. This study evaluates the efficacy and toxicity of the intensive alternating chemotherapy regimen BOMP/EPI in these patients. Patients and methods: Patients with IGCCC poor-prognosis germ-cell tumors treated at 13 centres were studied. Treatment consisted of bleomycin 30 mg, vincristine 2 mg, methotrexate 300 mg/m(2) and cisplatin 100 mg/m(2) (BOMP), alternating after a 14-day interval with etoposide 120 mg/m(2) day 1-4, ifosfamide 1.3 g/m(2) day 1-4 and cisplatin 25 mg/m(2) day 1-4 (EPI). POMP was administered 21 days after the EPI. Bleomycin was administered weekly per 12 weeks. Results: Thirty-eight patients were treated. The median number of cycles administered was 7 (1-10 cycles). Eighteen patients achieved complete responses with chemotherapy alone (12 had necrosis and 2 mature teratoma at postchemotherapy resection), and four achieved complete responses with chemotherapy and surgical resection of viable cancer. Thus, an overall favorable response was achieved in 22 patients (60%). Four additional patients had marker-negative non-resected residual masses. Eleven patients were consider-ed treatment failures, including one who died early and another who succumbed to granulocytopenic sepsis and renal failure. Hematologic toxicity was the most common, with 26 patients (70%) having grade 4 granulocytopenia. After a median follow-up of 41 months, the actuarial two-year overall survival and progression-free survival were 64% and 58%, respectively. Conclusion: BOMP/EPI is active in poor-prognosis germ-cell tumors according to the IGCCC criteria. The results obtained compare favorably with those expected with conventional chemotherapy, and justify further studies.