4 cycles of BEP remain the standard therapy for patients with disseminated germ cell tumours. The VIP regimen may be considered a treatment alternative for patients with underlying pulmonary disease.
The evidence supporting this regimen comes from the intergroup trial which compared the standard therapy of bleomycin, etoposide and cisplatin (BEP) with etoposide, ifosfamide and cisplatin (VIP) in advanced germ cell tumours. The results of the trial were reanalysed using the IGCCCG staging system by Hinton et al.r
From October 1987 to April 1992, 286 eligible patients were randomised to receive either BEP or VIP. Progression-free survival (PFS), overall survival (OS), and toxicity were assessed for the treatment arms.r
With a median follow up of 7.3 years, the PFS rates were 64% versus 58% and the OS rates 69% versus 67% in the VIP and BEP arms respectively. For patients reclassified with the IGCCCG staging system, the PFS rates were 81%, 72% and 54% and the OS rates were 89%, 81% and 60% for good, intermediate and poor risk patients respectively. Difference in OS (VIP 62%, BEP 57%) and PFS (VIP 56%, BEP 49%) for the subset of patients reclassified as poor risk were not significantly different.r
Overall survival by treatment stage for patients classified as having poor prognosis by IGCCCGr
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Haematological toxicity was the most common toxicity in both arms. 3 possible drug related deaths occurred in good or intermediate risk patients. In the VIP arm, 1 good risk patient died from sepsis. In the BEP arm, 2 intermediate risk patients died from sepsis, 1 from pulmonary haemorrhage and 1 death typical of bleomycin after a total dose of 300 000 International units.
||Grade 3/4 toxicity(%)r