Clinical outcomes of a 3-day modified BEP regimen in malignant ovarian germ cell tumors in a single-center real-world study

Malignant ovarian germ cell tumors (MOGCTs) mainly affect adolescents and young women and are highly curable with bleomycin, etoposide, and cisplatin (BEP). To reduce toxicity associated with the standard 5-day regimen, we evaluated the efficacy, safety, and fertility outcomes of a 3-day modified BEP regimen in patients with MOGCTs.

We conducted a retrospective analysis of 81 MOGCT patients with 3-day modified BEP at the Women’s Hospital, Zhejiang University School of Medicine from 2004 to 2024. The 3-day modified BEP regimen comprised bleomycin (15 U) and etoposide (100 mg/m²) on days 1–3, and cisplatin (75 mg/m²) on day 1, repeated every 4 weeks for 3–6 cycles.

All 81 MOGCT patients included in our study underwent primary surgery before chemotherapy; 86.4% had early-stage disease, and fertility-sparing surgery was performed in 73 cases. After a median follow-up of over 9 years, the 5-year progression-free survival rate was 97.5% (95% CI: 94.2–100), with no treatment-related deaths. Bleomycin-induced pneumonitis occurred in 4.9% and resolved with supportive care. Among 30 patients attempting conception, 90% achieved pregnancy, resulting in 25 term live births.

The 3-day modified BEP regimen provides excellent survival with reduced toxicity, offering greater convenience and preserved fertility, supporting its use as a safer and more practical treatment alternative for initial chemotherapy in MOGCTs.