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Germ Cell Tumours · Medical · Good-risk metastatic NSGCT

MRC/EORTC BEP vs CEB

In good-prognosis metastatic nonseminomatous germ-cell cancer, is carboplatin-based CEB chemotherapy equivalent to cisplatin-based BEP?

PopulationGood-prognosis metastatic NSGCT.InterventionFour cycles of BEP.ComparatorFour cycles of CEB using carboplatin.Randomized598 patients allocated in the efficacy analysis.

Absolute Effect

Complete response
94.4% vs 87.3% (+7.1 points)

BEP versus CEB among response-assessable patients, P=.009.

3-year survival
97% vs 90% (+7 points)

10 deaths occurred with BEP versus 27 with CEB; P=.003.

Failure-free survival

At 1 year, failure-free survival was 91% with BEP versus 77% with CEB, an absolute difference of 14 points.

Clinical interpretation

Carboplatin substitution was inferior to cisplatin in this curative-intent population.

The absolute differences in response, failure-free survival and survival are clinically important because metastatic germ-cell cancer is highly curable and small reductions in cure probability matter.

NNT

Using the 3-year survival difference, NNT ≈ 14. Using the 1-year failure-free survival difference, NNT ≈ 7.

Limitations

Historical chemotherapy dosing and supportive care differ from current practice, but the randomized comparison remains foundational for the cisplatin-based standard.

Primary / authoritative sources

MRC/EORTC BEP vs CEB — PubMed

Current-practice context · reviewed 14 October 2026

BEP remains the established cisplatin-based regimen for metastatic germ-cell tumours; CEB was not shown to be a safer equivalent substitute and is not the preferred routine regimen. Bleomycin contraindications, renal function, pulmonary risk and prognosis should be managed through an experienced germ-cell tumour team using current risk-adapted protocols.

Current guideline guidance ↗