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Japanese Journal of Clinical Oncology Advance Access published online on June 20, 2006
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyl053
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© 2006 Foundation for Promotion of Cancer Research
Received December 25, 2005
Accepted April 3, 2006

Original Article

Completion and Toxicity of Induction Chemotherapy for Metastatic Testicular Cancer: An Updated Evaluation of Japanese Patients

Koji Kawai 1 *, Satoshi Ando 1, Shiro Hinotsu 1, Takehiro Oikawa 1, Noritoshi Sekido 1, Naoto Miyanaga 1, Toru Shimazui 1, and Hideyuki Akaza 1

1 University of Tsukuba, Graduate School of Comprehensive Human Sciences, Institute of Clinical Medicine, Department of Urology, Tsukuba, Ibaraki, Japan

* To whom correspondence should be addressed.
Koji Kawai, E-mail: rkawa{at}md.tsukuba.ac.jp


  Abstract

Background: 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.

Methods: 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.

Results: 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%.

Conclusion: BEP with high RDIs is acceptable if combined with modern supportive care, with acceptable toxicity profile in most patients.

Keywords: testicular cancer; BEP; toxicity; IGCCCG classification.
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