-
European Neurology 2002
Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cannabis; Carboplatin; Drug Interactions; Etoposide; Fatal Outcome; Humans; Male; Neoplasms, Germ Cell and Embryonal; Stroke; Testicular Neoplasms
PubMed: 12373036
DOI: 10.1159/000065511 -
Gynecologic Oncology Jul 1998To evaluate the outcome and the prognosis of patients with ovarian germ cell malignancies who were treated with platinum-based chemotherapy immediately after initial...
PURPOSE
To evaluate the outcome and the prognosis of patients with ovarian germ cell malignancies who were treated with platinum-based chemotherapy immediately after initial surgery.
METHODS
We conducted a retrospective review of patients with ovarian germ cell tumors who were referred for consideration of treatment to the Departments of Medical Oncology participating in the Hellenic Cooperative Oncology Group.
RESULTS
Over a 14-year period 53 patients were included in our study. There were 13 patients with dysgerminoma and 40 patients with nondysgerminomatous tumors. Forty percent of patients underwent complete resection of their tumors. Platinum-based chemotherapy consisted primarily of cisplatin, vinblastine, and bleomycin (PVB) in 9 patients; bleomycin, etoposide, and cisplatin (BEP) in 15 patients; and bleomycin, etoposide, and carboplatin (BEC) in 25 patients. With a median follow-up of 39 months, 5 patients developed progressive disease and died of their tumor and 1 patient died of bleomycin-induced lung toxicity with no evidence of active tumor. The 5-year overall survival was 100% for patients with dysgerminoma and 85% for patients with nondysgerminomatous tumors. Eighty percent of patients with advanced nondysgerminomatous tumors and residual disease after surgery remain disease free.
CONCLUSION
With this study we confirm that patients with ovarian germ cell malignancies have a favorable outcome when treated with platinum-based chemotherapy.
Topics: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Carboplatin; Child; Cisplatin; Etoposide; Female; Germinoma; Humans; Middle Aged; Ovarian Neoplasms; Prognosis; Retrospective Studies; Survival Rate; Treatment Outcome; Vinblastine
PubMed: 9698477
DOI: 10.1006/gyno.1998.5047 -
Journal of Clinical Oncology : Official... May 1997This prospective randomized multicenter trial was designed to evaluate the efficacy of carboplatin plus etoposide and bleomycin (CEB) versus cisplatin plus etoposide and... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
Randomized trial of bleomycin, etoposide, and cisplatin compared with bleomycin, etoposide, and carboplatin in good-prognosis metastatic nonseminomatous germ cell cancer: a Multiinstitutional Medical Research Council/European Organization for Research and Treatment of Cancer Trial.
PURPOSE
This prospective randomized multicenter trial was designed to evaluate the efficacy of carboplatin plus etoposide and bleomycin (CEB) versus cisplatin plus etoposide and bleomycin (BEP) in first-line chemotherapy of patients with good-risk nonseminomatous germ cell tumors.
PATIENTS AND METHODS
Between September 1989 and May 1993, a total of 598 patients with good-risk nonseminomatous germ cell tumors were randomized to receive four cycles of either BEP or CEB. In each cycle, the etoposide dose was 120 mg/m2 on days 1, 2, and 3, and the bleomycin dose was 30 U on day 2. BEP patients received cisplatin at 20 mg/m2/d on days 1 to 5 or 50 mg/m2 on days 1 and 2. For CEB patients, the carboplatin dose was calculated from the glomerular filtration rate to achieve a serum concentration x time of 5 mg/mL x minutes. Chemotherapy was recycled at 21-day intervals to a total of four cycles.
RESULTS
Of patients assessable for response, 253 of 268 (94.4%) of those allocated to receive BEP achieved a complete response, compared with 227 of 260 (87.3%) allocated to receive CEB (P = .009). There were 30 treatment failures in the 300 patients allocated to BEP and 79 in the 298 allocated to CEB (log-rank chi 2 = 26.9; P < .001), which led to failure-free rates at 1 year of 91% (95% confidence interval [CI], 88% to 94%) and 77% (95% CI, 72% to 82%), respectively. There were 10 deaths in patients allocated to BEP and 27 in patients allocated to CEB (log-rank chi 2 = 8.77; P = .003), which led to 3-year survival rates of 97% (95% CI, 95% to 99%) and 90% (95% CI, 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.
Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Carboplatin; Cisplatin; Disease-Free Survival; Etoposide; Germinoma; Humans; Male; Prognosis; Remission Induction; Testicular Neoplasms
PubMed: 9164194
DOI: 10.1200/JCO.1997.15.5.1844 -
European Urology May 2000In order to reduce therapy-related morbidity in patients with nonseminomatous testicular germ cell tumors in clinical stage IIA/B, we performed a prospective multicenter... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
BACKGROUND
In order to reduce therapy-related morbidity in patients with nonseminomatous testicular germ cell tumors in clinical stage IIA/B, we performed a prospective multicenter trial comparing the standard retroperitoneal lymph node dissection (RPLND) +2 cycles of chemotherapy (arm A) with 3-4 cycles of primary chemotherapy (arm B).
METHODS
From February 1991 to July 1995, 57 participating centers from Germany and Austria recruited 187 evaluable patients. 109 received primary RPLND and 78 primary chemotherapy. Two different chemotherapies were applied (PEB and CEB as adjuvant or inductive treatment). The quality of life (QoL), therapy-related morbidity, suspected predictive factors (histology and size of metastases), and outcome were assessed.
RESULTS
In arm A, 12% had pathological stage (PS) I, 70% PS II A/B, and 18% PS II C/III. In arm B, 67% achieved complete remission with chemotherapy alone, 33% required a secondary RPLND. After a median follow-up of 36 months, 7% of the patients in arm A and 11% in arm B had relapsed. Two patients died due to complications of chemotherapy. Surgical complications amounted to 12% in arm A and 27% of 26 postchemotherapy RPLNDs (9% in arm B). Loss of ejaculation occurred in 32% in arm A, and 16% in arm B. Acute toxicity of chemotherapy was higher in the group receiving primary chemotherapy.
CONCLUSION
We recommend primary RPLND because adjuvant chemotherapy can be spared in PS I, two cycles of chemotherapy are less toxic than 3 or 4 cycles, the primary operation is associated with less complications than that following chemotherapy and, with modern surgical procedures, ejaculation can be preserved in most of the patients, provided that the operation is carried out by an experienced surgeon. No statistically significant differences in the QoL outcome occurred between the treatment groups, suggesting that chemotherapy alone is not superior to primary or secondary RPLND in this respect.
Topics: Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Carboplatin; Cisplatin; Etoposide; Germinoma; Humans; Lymph Node Excision; Male; Neoplasm Staging; Quality of Life; Retroperitoneal Space; Testicular Neoplasms
PubMed: 10765098
DOI: 10.1159/000020197 -
Oncology Aug 2000The prognosis of germ cell tumors treated with chemotherapy depends on the presence of nonseminomatous tumor, clinical parameters based on the tumor volume and site, as... (Clinical Trial)
Clinical Trial
Risk-adapted chemotherapy of germ cell tumors with carboplatin, etoposide and bleomycin for low-risk and cisplatin, etoposide and ifosfamide for high-risk patients. A single-center study.
The prognosis of germ cell tumors treated with chemotherapy depends on the presence of nonseminomatous tumor, clinical parameters based on the tumor volume and site, as well as on the level of the tumor markers AFP, betaHCG and LDH. We report here on the results of a risk-adapted approach to the chemotherapy of germ cell tumors. Patients with low-risk tumors, defined as seminomatous disease and/or nonseminomatous disease with a tumor mass <10 cm, less than 20 lung metastases, no liver, bone, or CNS metastases, and levels of AFP <1,000 IU/ml and betaHCG <10,000 IU/l, were to receive 4 cycles of carboplatin 400 mg/m(2) i.v. day 1, etoposide 120 mg/m(2) i.v. days 1-3 and bleomycin 30 IU i.v. days 1, 8 and 15 during the first 3 cycles (CEB(90)). Patients with high-risk disease were to receive 4 cycles of ifosfamide 1,500 mg/m(2) continuous infusion on days 1-4 together with mesna 1,200 mg/m(2) days 1-5, cisplatin 20 mg/m(2) i.v. days 1-5 and etoposide 100 mg/m(2) i.v. days 1-5 (VIP). Of the 60 patients treated with this risk-adapted approach, 51 had low-risk and 9 had high-risk disease. Forty-five of 51 patiens treated with CEB(90) achieved complete remission (CR), 4 achieved partial remission with marker negativity. Four patients with CR relapsed between 4 to 8 months after the start of chemotherapy. Of the 6 patients failing CEB(90), 3 were treated successfully with surgery or further chemotherapy. With a median follow-up of 52 months, the estimated cause-specific 3-year survival is 93% (95% confidence interval, CI, 80-98%). Seven of 9 high-risk patients treated with VIP achieved a CR and 1 patient relapsed. All 3 patients failing VIP had successful salvage therapy. With a medium follow-up of 63 months all patients remain alive and free of disease. Forty-six patients receiving CEB(90) were retrospectively classified to be in the good prognosis group according to the international germ cell consensus classification. Their estimated 3-year survival was 95% (CI 81-99%). We thus confirm that CEB(90) is a well-tolerated outpatient regimen with good results in good prognosis germ cell tumors. Bleomycin at a cumulative dose of 270 U might contribute substantially to the inferior effect of carboplatin as compared to cisplatin. However, in view of the results of randomized studies favoring cisplatin over carboplatin, it is not recommended to use this regimen outside a clinical trial.
Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Carboplatin; Cisplatin; Etoposide; Follow-Up Studies; Germinoma; Humans; Ifosfamide; Middle Aged; Risk Factors; Treatment Outcome
PubMed: 10971168
DOI: 10.1159/000012146 -
Annals of Oncology : Official Journal... Dec 1996Cisplatin-based combination chemotherapy will cure 70% to 80% of patients with metastatic non-seminomatous germ cell tumors but is associated with the possibility of... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
A randomized trial of cisplatin, etoposide and bleomycin (PEB) versus carboplatin, etoposide and bleomycin (CEB) for patients with 'good-risk' metastatic non-seminomatous germ cell tumors.
BACKGROUND
Cisplatin-based combination chemotherapy will cure 70% to 80% of patients with metastatic non-seminomatous germ cell tumors but is associated with the possibility of severe neuro-, oto- and nephro-toxicities. Carboplatin, a cisplatin analogue, is an active drug in testicular cancer with a more favourable spectrum of side effects. In a randomized trial, the German Testicular Cancer Study Group compared a combination regimen of carboplatin, etoposide and bleomycin (CEB) to standard cisplatin, etoposide and bleomycin (PEB) chemotherapy for patients with 'minimal-' and moderate-disease' non-seminomatous germ cell tumors, according to the Indiana University classification.
PATIENTS AND METHODS
PEB was given for three cycles at standard doses (given days 1-5), and the CEB regimen consisted of carboplatin (target AUC of 5 mg/ml x min) on day 1, etoposide 120 mg/m2 on days 1 to 3 and bleomycin 30 mg on days 1, 8 and 15. Four cycles of CEB were given, with the omission of bleomycin in the fourth cycle. Thus, the cumulative doses of etoposide and bleomycin applied in the two treatment arms were comparable. Fifty-four patients were entered on the trial, 29 were treated with PEB and 25 with CEB chemotherapy. Patients were stratified according to disease extent (minimal versus moderate) and the degree of tumor marker elevation. Thirty-two patients (59%) belonged to the group with minimal disease and low markers.
RESULTS
No significant difference in response to chemotherapy was seen between the two arms, with CR rates of 81% for the PEB arm and 76% for CEB treatment. However, more patients treated with CEB (32% versus 13%) have relapsed after therapy, and 4 patients (16%) have died of disease progression after CEP in contrast to 1 (3%) after PEB therapy. The first interim analysis of negative events (relapse, vital tumor at secondary resection, death from disease and therapy-associated death) showed a significantly higher rate after CEB than after PEB therapy, and the trial was terminated early. After a median follow-up of 33 months for all patients, the calculation of negative events is still significantly in favour of PEB-treated patient, particularly since three late relapses > 2 years have been observed in the CEB arm (P = 0.03).
CONCLUSION
This randomized trial demonstrates that even with the use of adequate doses of etoposide and full-dose bleomycin, carboplatin cannot altogether replace cisplatin in patients with testicular cancer. Treatment with the PEB regimen remains the standard approach in patients with 'good-risk' non-seminomatous germ cell tumors.
Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Carboplatin; Cisplatin; Drug Administration Schedule; Etoposide; Germinoma; Humans; Male; Middle Aged; Prognosis; Risk Factors; Testicular Neoplasms
PubMed: 9037359
DOI: 10.1093/oxfordjournals.annonc.a010493 -
The Netherlands Journal of Medicine Feb 2003Bleomycin is to treat patients with testicular cancer and lymphoma. Bleomycin can bind to DNA and chelate iron. The resulting complex can form an intermediate capable of...
Bleomycin is to treat patients with testicular cancer and lymphoma. Bleomycin can bind to DNA and chelate iron. The resulting complex can form an intermediate capable of interacting with oxygen to produce reactive oxygen species, particularly superoxide. Administrating high-inspired oxygen concentrations (e.g. during anaesthesia or acute illness) has been reported to exacerbate pulmonary injury. The duration of risk after bleomycin chemotherapy is unknown. Here we discuss our advice to a young male patient, who was successfully treated with bleomycin for testicular cancer, concerning the safety to return to scuba diving. Since scuba divers are exposed to high partial oxygen pressures (depending on the depth of the dive) we discouraged this patient from resuming scuba diving.
Topics: Adult; Antibiotics, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Carboplatin; Choriocarcinoma; Diving; Etoposide; Humans; Lung Diseases; Male; Orchiectomy; Testicular Neoplasms
PubMed: 12735422
DOI: No ID Found -
The Journal of Reproductive Medicine Jul 2008To review results in treatment of high-risk metastatic gestational trophoblastic neoplasia (GTN) in Hungary.
OBJECTIVE
To review results in treatment of high-risk metastatic gestational trophoblastic neoplasia (GTN) in Hungary.
STUDY DESIGN
Between January 1, 1977, and December 31, 2006, 142 patients with high-risk metastatic GTN were treated. Patients were 14-51 years of age (average 27.9). We selected primary chemotherapy based on patient GTN stage and prognostic score.
RESULTS
Methotrexate, actinomycin-D and cyclophosphamide (MAC) as a primary therapy was used in 100 cases and as second-line chemotherapy in 6 cases. Of the 100 cases, 95 achieved complete remission. Twenty-one high-risk patients were treated with etoposide, high-dose methotrexate with folinic acid rescue, actinomycin-D, cyclophosphamide and vincristine (EMA-CO). Of 17 primary therapies, 13 patients achieved complete remission. Primary cisplatin, etoposide and bleomycin (CEB) was successful in 12 of 14 high-risk cases. Hysterectomy was performed in 42 of 142 high-risk patients; metastases were resected in 26 of 142 of high-risk patients. Comparison of mean prognostic scores resulted in significant differences between CEB and MAC, CEB and EMA-CO and MAC and EMA-CO.
CONCLUSION
Results support that patients with high-risk metastatic GTN should primarily be treated with combination chemotherapy. Our data support the effectiveness of MAC, EMA-CO and CEB regimens.
Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Carboplatin; Cisplatin; Cyclophosphamide; Dactinomycin; Etoposide; Female; Gestational Trophoblastic Disease; Humans; Hungary; Hysterectomy; Methotrexate; Middle Aged; Pregnancy; Risk Factors; Vincristine; Young Adult
PubMed: 18720931
DOI: No ID Found -
Anticancer Research 2003We investigated the efficacy and safety of 2 cycles of adjuvant chemotherapy with carboplatin, etoposide and bleomycin (CEB90) in patients with high-risk clinical stage... (Clinical Trial)
Clinical Trial
BACKGROUND
We investigated the efficacy and safety of 2 cycles of adjuvant chemotherapy with carboplatin, etoposide and bleomycin (CEB90) in patients with high-risk clinical stage I or stage IM non-seminomatous germ cell tumours (NSGCT).
PATIENTS AND METHODS
A total of 52 consecutive patients (22 patients with high-risk histological features [vascular invasion, presence of embryonal carcinoma, absence of yolk sac tumour] and 30 with tumour marker activity post-orchidectomy-stage IM) were entered into this prospective study. Chemotherapy consisted of carboplatin 400 mg/m2 or AUC 5 (day 1), etoposide 165 mg/m2 (days 1-3) and bleomycin 30 mg (days 1, 8, 15). Chemotherapy was repeated every 3 weeks.
RESULTS
During a median follow-up of 112 months (range, 10 to 174 months), two patietns with stage IM relapsed. These cases had a disseminated, marker-positive germ cell tumour (GCT), extensively involving both liver and lungs in the first case and para-aortic lymph nodes and lung in the second one; both patients died of the tumour after a number of salvage chemotherapy (including high-dose therapy) regimens. Fifty patients (96%) are alive and disease-free. Two cycles of CEB90 were well tolerated and the only side-effects were myelotoxicity and alopecia.
CONCLUSION
Despite the general consensus that ciplatin-based chemotherapy is superior to carboplatin-containing regimens in testicular cancer, 2 cycles of CEB90 may be an equally effective treatment option as adjuvant therapy for high-risk clinical stage I and IM patients.
Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Carboplatin; Carcinoma, Embryonal; Chemotherapy, Adjuvant; Drug Administration Schedule; Etoposide; Germinoma; Humans; Male; Neoplasm Staging; Orchiectomy; Prospective Studies; Testicular Neoplasms
PubMed: 14666633
DOI: No ID Found -
Haematologica 1996Hodgkin's disease (HD) after the age of 65 years is uncommon and there are no published data on chemotherapy regimens devised for elderly HD patients.
BACKGROUND
Hodgkin's disease (HD) after the age of 65 years is uncommon and there are no published data on chemotherapy regimens devised for elderly HD patients.
PATIENTS AND METHODS
From 1990 to 1993, 25 elderly HD patients were treated with the CVP/CEB regimen: chlorambucil 6 mg/sqm p.o. days 1 through 7, vinblastine 6 mg/sqm i.v. on day 1, procarbazine 100 mg/sqm p.o. days 1 through 7, prednisone 30 mg/sqm p.o. days 1 through 7, cyclophosphamide 500 mg./sqm i.v. day 15, etoposide 70 mg/sqm i.v. day 15, bleomycin 10 mg/sqm i.v. day 15. Each course was repeated every 4 weeks. Stage I and II patients were treated with 3 courses followed by involved field radiotherapy, while more advanced stage patients received 6 courses and radiotherapy was limited to bulky areas. The results of the CVP/CEB regimen are retrospectively compared to those of 74 elderly patients treated between 1982 and 1989 and subdivided into the following 2 groups: 32 patients treated according to the same therapy used at that time in younger patients, and 42 patients given alternative low aggressivity or palliative treatment.
RESULTS
CVP/CEB is a well-tolerated regimen, with only 1 (4%) toxic death and 2 (8%) protocol violations/interruptions. The CVP/CEB complete remission rate (73%) compares favorably with our previous groups of patients, mainly because of the lower toxic death rate. However, the CVP/CEB relapse-free survival rate is lower than that of patients treated with more aggressive conventional regimens (47% vs. 77%, p < 0.02). The CVP/CEB overall survival and event-free survival rates are 55% and 32%, respectively, and they are not statistically different from those of patients treated before 1990.
CONCLUSIONS
CVP/CEB is a well-tolerated low toxicity regimen with a high CR rate. The relapse rate is high and event-free survival is comparable to that of patients treated conventionally. Our results suggest the need for individualized treatment criteria for older patients with HD.
Topics: Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Carboplatin; Cyclophosphamide; Etoposide; Hodgkin Disease; Humans; Prednisone; Treatment Outcome; Vincristine
PubMed: 8952159
DOI: No ID Found