# Treatment of disseminated germ cell tumours with cisplatin, bleomycin and either vinblastine or etoposide

Source: https://onco.cc/key-papers/paper-williams-bep-vs-pvb-nejm-1987/  
OnCo record `paper-williams-bep-vs-pvb-nejm-1987` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Replacing vinblastine with etoposide in cisplatin-based chemotherapy for testicular cancer cured as many men with far less nerve and muscle toxicity and improved survival in advanced disease, establishing the BEP regimen used ever since.

## Summary

Phase 3 trial of 261 men with disseminated germ cell tumours randomised to cisplatin, bleomycin and vinblastine (PVB) or cisplatin, bleomycin and etoposide (BEP).

Complete response rates were similar (74 versus 83 percent), but BEP caused less neuromuscular toxicity, and in patients with advanced disease it gave higher disease-free and overall survival.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: New England Journal of Medicine
- Year: 1987
- DOI: 10.1056/NEJM198706043162302
- Authors: Williams SD, Birch R, Einhorn LH, et al.
- Findings: Disease-free status in 61 percent (PVB) vs 60 percent (BEP) overall; superior survival with BEP in advanced disease.; Substantially less neuromuscular toxicity with BEP.
- What it means: BEP has been the backbone of curative chemotherapy for testicular cancer for nearly forty years.
- Caveats: Small trial by modern standards; later trials defined cycle number by risk group.

## Sources

- N Engl J Med 1987: https://doi.org/10.1056/NEJM198706043162302
- PubMed: https://pubmed.ncbi.nlm.nih.gov/2437455/

## Connected records

- cancers: [Non-seminomatous germ cell tumour](https://onco.cc/cancers/non-seminoma/)
- drugs: [Bleomycin](https://onco.cc/drugs/bleomycin/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Etoposide](https://onco.cc/drugs/etoposide/), [Vinblastine](https://onco.cc/drugs/vinblastine/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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