Bleomycin in Combination Chemotherapy of Testicular or Extragonadal Germ Cell Tumours: a Review of Published Trials

Bleomycin, Etoposide and Cisplatin remain the standard chemotherapy for metastatic germ cell cancer, despite up to one third of patients having some evidence of lung toxicity [1]. Most large series report treatment related deaths due to Bleomycin lung but there are at least three clinical trials providing evidence that it is not safe to drop bleomycin [2–4]. Prompted by the need to find safe ways to reduce toxicity in good risk patients, this paper reviews the evidence for the benefit of Bleomycin in germ cell cancer and data from a series of sequential phase 2 studies undertaken by the Anglian Germ Cell Cancer Group developing new schedules aimed at reducing the risk of toxicity and maintaining or increasing its activity.