Kawai Koji, Ando Satoshi, Hinotsu Shiro, Oikawa Takehiro, Sekido Noritoshi, Miyanaga Naoto, Shimazui Toru, Akaza Hideyuki
Department of Urology, University of Tsukuba, Ibaraki 305, Japan.
Jpn J Clin Oncol. 2006 Jul;36(7):425-31. doi: 10.1093/jjco/hyl053. Epub 2006 Jun 20.
Combination of bleomycin, etoposide and cisplatin (BEP) remains the standard chemotherapy for testicular cancer. Since the development of BEP in the 1980s, there has been a considerable advance in supportive therapies, such as granulocyte colony-stimulating-factor and 5-HT3 antagonists. Therefore, we re-evaluated the completion and toxicity of BEP combined with modern supportive care.
The medical records of all 42 testicular cancer patients who received induction chemotherapy at Tsukuba University Hospital were reviewed. Toxicities during the induction chemotherapy were graded according to the Japanese CTCAE v3.0.
Dose reduction was needed in only three patients. The subsequent chemotherapy was started at the planned 3 week interval or within 3 days of postponement in 89% of the treatment cycles. The average relative dose intensity (RDI) of bleomycin was 0.95, while that for etoposide and cisplatin was 0.97. There was no death due to toxicity. The most frequent toxicity was leukopenia (grade 3 in 44% and grade 4 in 55%). Post-chemotherapy diffusion capacity was significantly decreased in 30% of patients. Two patients developed bleomycin-induced pneumonitis, but recovered successfully. Sixteen patients received second line or salvage chemotherapy after BEP, subsequently. The overall 5 year cause-specific survival rate was 85%.
BEP with high RDIs is acceptable if combined with modern supportive care, with acceptable toxicity profile in most patients.
博来霉素、依托泊苷和顺铂联合方案（BEP）仍是睾丸癌的标准化疗方案。自20世纪80年代BEP方案问世以来，在支持性治疗方面取得了显著进展，如粒细胞集落刺激因子和5-羟色胺3拮抗剂。因此，我们重新评估了BEP联合现代支持性治疗的完成情况和毒性。
回顾了筑波大学医院所有42例接受诱导化疗的睾丸癌患者的病历。诱导化疗期间的毒性根据日本CTCAE v3.0进行分级。
仅3例患者需要降低剂量。89%的治疗周期后续化疗按计划的3周间隔或推迟3天内开始。博来霉素的平均相对剂量强度（RDI）为0.95，依托泊苷和顺铂的平均相对剂量强度为0.97。无因毒性导致的死亡。最常见的毒性是白细胞减少（44%为3级，55%为4级）。30%的患者化疗后弥散功能显著下降。2例患者发生博来霉素诱导的肺炎，但成功康复。16例患者随后在BEP方案后接受了二线或挽救性化疗。总体5年病因特异性生存率为85%。
如果联合现代支持性治疗，高RDI的BEP方案是可以接受的，大多数患者的毒性情况可接受。
