• Failure-free survival as measured by Logrank [ Designated as safety issue: No ]
  

• Response to treatment as measured by normalized markers without residual viable cancer after CT scan or surgery [ Designated as safety issue: No ]
  
• Overall survival as measured by Logrank at end of each course, at 6 weeks after completion of study treatment, every 6 months up to year 5, and then annually thereafter [ Designated as safety issue: No ]
  
• Disease-free survival as measured by Logrank at end of each course, at 6 weeks after completion of study treatment, every 6 months up to year 5, and then annually thereafter [ Designated as safety issue: No ]
  
• Toxicity as measured by NCI-CTC v2.0 at end of each course, at 6 weeks after completion of study treatment, every 6 months up to year 5, and then annually thereafter [ Designated as safety issue: Yes ]
  
• Quality of life as measured by Quality of Life Questionnaire Core 30 (QLQ-C30) at baseline, during treatment, and at years 1 and 2 [ Designated as safety issue: No ]
  

OBJECTIVES:

Phase II

• Compare the complete response rates in men with intermediate prognosis germ cell cancer treated with bleomycin, cisplatin, and etoposide (BEP) vs bleomycin, cisplatin, etoposide, and paclitaxel (T-BEP).
• Define the toxicity profile of T-BEP in these patients.

Phase III

• Compare the disease-free survival of patients treated with these regimens.
• Compare the complete response rates and overall survival of patients treated with these regimens.
• Compare symptoms and aspects of quality of life at baseline and after treatment in patients treated with these regimens.
• Compare the acute and intermediate (1-2 years) side effects of these regimens in these patients.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to histology (seminoma vs non-seminoma) and hospital. Patients are randomized to 1 of 2 treatment arms.

• Arm I: Patients receive cisplatin IV and etoposide IV on days 1-5 and bleomycin IV on days 1, 8, and 15.
• Arm II: Patients receive cisplatin, etoposide, and bleomycin as in arm I and paclitaxel IV over 3 hours on day 1. Patients also receive filgrastim (G-CSF) subcutaneously on days 6-15.

In both arms, treatment repeats every 3 weeks for a total of 4 courses in the absence of disease progression or unacceptable toxicity.

Quality of life is assessed before treatment randomization and at 1 and 2 years after randomization.

Patients are followed monthly for 1 year, every 2 months for 1 year, every 3 months for 1 year, every 6 months for 1 year, and then annually thereafter.

PROJECTED ACCRUAL: A total of 84-164 patients (42-82 per treatment arm) will be accrued for the phase II study. A total of 498 patients (249 per treatment arm) will be accrued for the phase III study. Accrual will be completed within 4 years.

DISEASE CHARACTERISTICS:

• Histologically proven germ cell cancer

  • Seminoma
  • Non-seminoma
  • Combined

• Intermediate prognosis

  • Non-seminoma:

    • Testis/retroperitoneal primary
    • No non-pulmonary visceral metastases

    • Meets 1 of the following criteria:

      • Alpha-fetoprotein (AFP) 1,000- 10,000 IU/L
      • Human chorionic gonadotropin (hCG) 5,000-50,000 IU/L
      • Lactic dehydrogenase (LDH) 1.5 times-10 times upper limit of normal (ULN)

  • Seminoma:

    • Any primary site
    • Any LDH and HCG
    • AFP normal
    • Non-pulmonary visceral metastases present

PATIENT CHARACTERISTICS:

Age:

• 16 to 50

Sex:

• Male

Performance status:

• WHO 0-2

Life expectancy:

• Not specified

Hematopoietic:

• WBC at least 3,000/mm^3
• Platelet count at least 100,000/mm^3

Hepatic:

• Bilirubin no greater than 1.25 times ULN
• AST no greater than 2 times ULN

Renal:

• Creatinine clearance at least 40 mL/min (unless due to obstructive uropathy which can be relieved by nephrostomy)

Other:

• No pre-existing neuropathy
• No other malignancy except basal cell skin cancer
• No other serious illness or medical conditions incompatible with the protocol

PRIOR CONCURRENT THERAPY:

Biologic therapy:

• Not specified

Chemotherapy:

• No prior chemotherapy

Endocrine therapy:

• Not specified

Radiotherapy:

• Not specified

Surgery:

• Not specified