Treatment outcome and cost-effectiveness analysis of two chemotherapeutic regimens (BEP vs. VIP) for poor-prognosis metastatic germ cell tumors.
BACKGROUND
In patients with small-volume disseminated disease of germ cell tumors, cure can be achieved with four cycles of bleomycin, etoposide, and cisplatin (BEP). However, around 20% of these cases are not curable. Strategies to improve cure rates have shown that none of the currently available modalities were superior to the others. Among the most used ones, BEP and VIP (etoposide, cisplatin, and ifosfamide) have been the most studied. However, there are no reports comparing the two, except for a few in abstract forms from southern India. Therefore, we did a treatment outcome and cost-effectiveness analysis of two chemotherapeutic regimens (BEP vs VIP) that are used in poor-prognosis metastatic germ cell tumors.


METHODS
All male patients with germ cell tumors, diagnosed as having poor risk by IGCCCG, between January 2002 and December 2004 were included in the study. Clinical, laboratory, and other data were recorded. The patients were stratified into two categories on the basis of the type of chemotherapeutic regimen they received.


RESULTS
In all, 46 patients were analyzed, with a median follow up of 26.6 months. The baseline characteristics (age, stage, PS, histology, and serum markers) were not different in the two treatment arms. There is no significant difference in the outcome with either of the chemotherapeutic modalities. VIP is less cost effective and more toxic compared to BEP.


CONCLUSIONS
In view of the greater toxicity and cost of therapy, as well as lack of either overall or disease free survival advantage, VIP is not a preferred option for patients with high-risk germ cell tumors in the Indian setting and it is still advisable to treat patients with BEP.
Attili
Venkata Satya Suresh
VS
Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore - 560 029, India. sureshattili@yahoo.com
Chandra
Rama C
RC
Anupama
G
G
Loknath
D
D
Bapsy
P P
PP
Dadhich
Hemant K
HK
Babu
Govind K
GK
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D001761:Bleomycin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D002945:Cisplatin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005047:Etoposide / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D007069:Ifosfamide / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000473:pathology*; D011034:Podophyllotoxin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D011379:Prognosis; D016896:Treatment Outcome
D001761:Bleomycin; D005047:Etoposide; D011034:Podophyllotoxin; D002945:Cisplatin; D007069:Ifosfamide