title: Completion and toxicity of induction chemotherapy for metastatic testicular cancer: an updated evaluation of Japanese patients.
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%.
  
  
  CONCLUSIONS
  BEP with high RDIs is acceptable if combined with modern supportive care, with acceptable toxicity profile in most patients.
authors.affiliation: Department of Urology, University of Tsukuba, Ibaraki 305, Japan. rkawa@md.tsukuba.ac.jp
authors.forename: Koji
authors.initials: K
authors.lastname: Kawai
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ando
authors.forename: Shiro
authors.initials: S
authors.lastname: Hinotsu
authors.forename: Takehiro
authors.initials: T
authors.lastname: Oikawa
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Sekido
authors.forename: Naoto
authors.initials: N
authors.lastname: Miyanaga
authors.forename: Toru
authors.initials: T
authors.lastname: Shimazui
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Akaza
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage / Q000009:adverse effects; D001853:Bone Marrow / Q000187:drug effects; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D004334:Drug Administration Schedule; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D018237:Germinoma / Q000188:drug therapy* / Q000401:mortality; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D006801:Humans; D007970:Leukopenia / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011994:Recombinant Proteins; D012702:Serotonin Antagonists / Q000008:administration & dosage; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000401:mortality; D013921:Thrombocytopenia / Q000139:chemically induced
chemical_list: D011994:Recombinant Proteins; D012702:Serotonin Antagonists; D001761:Bleomycin; D016179:Granulocyte Colony-Stimulating Factor; D005047:Etoposide; D002945:Cisplatin