Is bleomycin necessary in adjuvant chemotherapy of clinical stage I non-seminomatous testicular cancer?

The aim of our study was to assess the feasibility of bleomycin omission from two cycles of adjuvant bleomycin, etoposide and cysplatin (BEP) chemotherapy in patients with clinical stage I non-seminomatous germ cell tumors (NSGCT). A total of 41 patients with high risk clinical stage I NSGCT of the testis were treated with adjuvant chemotherapy at our center from October 1994 to June 2005. The criteria for high risk were lymphatic and/or vascular tumor invasion in the primary tumor. 24 patients underwent adjuvant chemotherapy with two standard cycles of BEP (I group) and 17 patients received two alternative cycles of EP (II group). Toxicity was analyzed on a per treatment cycle basis. One patient from group 1 required subsequent retroperitoneal lymph node dissection for recurrent mature teratoma. All the patients were alive and relapse-free at a median follow-up time of 75 and 49 months for groups 1 and 2 respectively. In patients from group 1 more number of treatment cycles was associated with grade 2-3 leukopenia compared to group 2 (p=0,043). The results of this study show that two cycles of EP regimen is as effective as two cycles of BEP chemotherapy in patients with clinical stage I NSGCT and may be suggested as a less toxic alternative approach to standard adjuvant treatment.