Intermediate risk n 4 cycles of BEP n Patients with pulmonary toxicity to BEP

Intermediate risk n 4 cycles of BEP n Patients with pulmonary toxicity to BEP can undergo alternative treatment with VIP n Poor risk n 4 cycles of BEP n Patients with pulmonary toxicity to BEP can undergo alternative treatment with VIP

+ NCCN Treatment Guidelines: Relapsed/Refractory Disease n Chemotherapy-naïve n Cisplatin-based regimen (3 cycles of BEP or 4 cycles of EP ) n Alternative RPLND n Post-orchiectomy chemotherapy n VIP combination regimen n Alternative options with vinblastine and paclitaxel (VeIP, TIP) n Relapsed within 4 weeks n Platinum-refractory; require extensive high-dose chemotherapy n Late-relapsing (>2 years) or brain metastases

+ Etoposide and Cisplatin (EP) in Good-Risk GCT n Need alternatives to decrease toxicity for good-risk GCT patients n BEP regimen associated with increased pulmonary toxicity due to bleomycin n Carboplatin in substitution for cisplatin produced inferior results n Kondagunta GV, Bacik J, Bajorin D, Dobrzynski D, Sheinfeld J, Motzer RJ, et. al. Etoposide and Cisplatin Chemotherapy for Metastatic Good-Risk Germ Cell Tumors . J of Clin Oncol. 2005 Dec 20;23(36):9290-9294.

+ Etoposide phosphate n Mechanism of Action: topoisomerase II inhibitor n Dosing: 50 to 100mg/m2 IV on days 1 to 5 every 3 to 4 weeks n Common Adverse Effects: alopecia, fever, malaise, GI effects n Kinetics n Distribution: 18 to 29L, protein binding 97% n Metabolism: hepatic n Excretion: predominantly renal n Half life: 4 to 11 hours

+ Cisplatin n Mechanism of Action: alkylating agent n Dosing: 20mg/m2 IV on days 1 to 5 every four weeks n Common Adverse Effects: hematologic n Kinetics n Distribution: 90% protein binding n Metabolism: platinum complexes n Excretion: predominantly renal n Half life: roughly 1 to 4 days .jpg

+ Methods n Population n 289 patients with good-risk GCT per IGCCCG n Intervention n Etoposide100mg/m2 and cisplatin 20mg/m2 on days 1 to 5 every three weeks for a total of four cycles n +/- surgical resection and +/- postsurgical chemotherapy n Endpoints n Complete versus incomplete response n Overall survival n Relapse-free survival n Statistics n Kaplan-Meier model