Full-Dose BEP Best for Ovarian Yolk Sac Tumours

A full-dose regimen of bleomycin, etoposide and cisplatin offers the best overall survival for women with ovarian yolk sac tumours

medwireNews: Patients with pure or mixed ovarian yolk sac tumours (YSTs) should be given a standard regimen of bleomycin , etoposide and cisplatin (BEP), say researchers who found that a reduced-dose regimen reduces survival without appearing to improve fertility outcomes.

Five-year overall survival (OS) was 93.6% in the 37 patients who received standard BEP after surgery, consisting of three or four cycles of bleomycin on days 2, 9 and 16 (20 mg/m2 per day or 30 mg/day) alongside etoposide (100 mg/m2 per day) and cisplatin (20 mg/m2 per day), both given on days 1 to 5.

This was significantly superior to the 5-year OS of 74.6% for the 99 patients who were given alternative chemotherapy regimens, such as cisplatin, vinblastine and bleomycin, report Toyomi Satoh, from the University of Tsukuba in Japan, and co-authors in the European Journal of Cancer.

And after excluding five patients with an uncertain or excessive dose of bleomycin, the estimated 5-year OS was 100% for the 37 patients given standard BEP compared with 91.0% for the 70 patients who were given a reduced-dose version of BEP.

Specifically, estimated 5-year OS fell from 100% for the 48 patients given 75% or more of the standard bleomycin dose to 89.4% for the 59 patients given a smaller dose proportion.

Similarly, estimated 5-year OS was significantly higher in the 98 patients who received at least 50% of the standard etoposide dose compared with the nine patients who were given less than 50% of the standard dose, at 96.9% versus 62.5%.

In multivariate analysis, age of 22 years or older, an alpha-fetoprotein level of 33,000 ng/mL or higher, residual tumours on primary surgery and receipt of non-BEP postoperative chemotherapy were also significant predictors of poor OS.

The retrospective study of patients treated between 1980 and 2007 also reported on reproductive outcomes for 74 patients given postoperative BEP and 35 patients treated with alternative postoperative chemotherapy regimens.

Two patients had menarche after treatment, and all but one patient, who had also received pelvic irradiation, recovered menstruation.

Twenty-six pregnancies resulting in 21 healthy infants were reported for 16 nulliparous patients given BEP, while 20 pregnancies resulting in 19 healthy infants were reported for 12 nulliparous patients treated with alternative regimens.

“Theoretically, a randomized controlled trial may be needed to establish that standard BEP is superior to both non-BEP and non-standard BEP for treatment of patients with YST”, admit Toyomi Satoh and team.

“However, such trials may not be ethically feasible”, they write.

The authors conclude: “The ovarian toxicity of BEP was not serious, and the probability of childbearing after treatment was ≥70% in patients with YST who received BEP.”


Satoh T, Aoki Y, Kasamatsu T, et al. Administration of standard-dose BEP regimen (bleomycin + etoposide + cisplatin) is essential for treatment of ovarian yolk sac tumour. Eur J Cancer 2015; Published online 2 January. doi:10.1016/j.ejca.2014.12.004

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