Accelerated BEP for metastatic germ cell tumours: a multicenter phase II trial by the Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP)

BACKGROUND

This Australian single-arm, multicenter, phase II trial evaluated feasibility, tolerability and activity of accelerated bleomycin, etoposide and cisplatin (BEP) as first-line chemotherapy for metastatic germ cell tumours.

PATIENTS AND METHODS

Patients were planned to receive cisplatin 20 mg/m(2) and etoposide 100 mg/m(2) days 1-5, and pegfilgrastim 6 mg day 6, all repeated every 2 weeks for four cycles (three cycles for good prognosis). Bleomycin was given at 30 000 IU weekly to a total of 12 doses (9 doses for good prognosis). Primary end point was feasibility, defined as the proportion of patients able to complete the etoposide and cisplatin components of BEP and be eligible to receive a fourth cycle of BEP by day 50.

RESULTS

Twelve poor, 16 intermediate and 15 good prognosis (n = 43) eligible patients were enrolled. Two patients aged >40 years were ineligible and excluded from analyses. The regimen was feasible in 86%, not feasible in 7% and not assessable in 7% of patients. Most common grade 3/4 adverse events were non-neutropenic infection (16%) and febrile neutropenia (12%). Complete response (CR) to chemotherapy and surgery was achieved in 33% poor-prognosis, 81% intermediate-prognosis and 100% good-prognosis patients. At median follow-up of 27 months (range 6-42), the 2-year progression-free survival was 50% for poor-prognosis, 94% for intermediate-prognosis and 92% for good-prognosis patients.

CONCLUSION

Accelerated BEP is feasible and tolerable. Efficacy data appear to be promising. This trial and a similar UK study provide the rationale for a randomised trial comparing accelerated versus standard BEP. Australian New Zealand Clinical Trials Registry Registration number. ACTRN 12607000294459.

The 'sweet killer'. Can you recognize the symptoms of ethylene glycol poisoning?

Ingested ethylene glycol is readily absorbed and metabolized into toxic metabolites that can cause CNS depression, cardiopulmonary failure, and renal failure. Thorough history taking, physical examination, and laboratory testing are essential for diagnosis. Careful differential diagnosis is important because symptoms of ethylene glycol poisoning are similar to those of other intoxicants. Early, aggressive treatment with appropriate therapies, such as ethanol therapy, hemodialysis, vitamin cofactors, and antidotal agents, is necessary to prevent permanent disability or death.

Muscle glycogen and diet in elite soccer players

The top players in an elite soccer team volunteered as subjects in a study to determine intramuscular glycogen concentrations after a regular season match, and whether optimal glycogen levels could be re-attained prior to the team's next match. Fifteen players were biopsied in the M. vastus lateralis following a regular season game (Day I). Of these, eight were biopsied 24 h later in the evening of a free day during which no training session was held (Day II), and again 24 h later after a very light training session (Day III). Muscle glycogen concentrations for the eight players averaged (+/- SD) 45.9 +/- 7.9, 68.9 +/- 2.7, and 72.8 +/- 8.3 mmol glucose units x kg-1 wet muscle weight on Day I, Day II, and Day III respectively. Dietary records were analysed during a week of peak, season competition and training. The average daily total energy consumption and total quantity of carbohydrates consumed were less than what is normally consumed by athletes in similar sports. The inability of the players to maintain even normal, resting levels of muscle glycogen is probably related to their dietary practices.

Estradiol receptor levels in human breast carcinomas

The presence or absence of a specific estradiol-binding protein receptor in the cytoplasm of primary and secondary tumour cells has been used by physicians as an important guide in deciding whether to use hormonal therapy for patients with metastatic breast cancer. This report gives the levels of estradiol receptors in the cytosol of 228 primary and secondary breast tumours, measured by a sensitive multiple-point assay in which dextran-coated charcoal separated bound form unbound estrogen. The data were analysed with a Scatchard plot. Of the 175 primary and 53 secondary tumours 53% and 32% respectively gave positive results. The mean receptor level in the primary tumours was significantly higher among older patients and increased with age. With metastatic lesions positive results were more common in lymph node samples tha in skin nodule samples.