ReviewFrontiers in immunology2026
Toxicity of BEP chemotherapy in germ cell tumors: focus on immune-mediated bleomycin pulmonary toxicity in comparison with EP and VIP regimens.
Review in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed.
- Longitudinal plasma and urinary SP-D and sRAGE during BEP chemotherapy in germ cell tumours.Frontiers in immunology · 2026Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Bleomycin, etoposide, and cisplatin (BEP) remains the cornerstone of curative first-line treatment for metastatic germ cell tumors (GCTs) across all prognostic risk groups. Although etoposide-cisplatin (EP) and etoposide-ifosfamide-cisplatin (VIP) are validated alternatives in selected clinical scenarios, oncologic efficacy among standard first-line cisplatin-based regimens is largely comparable within their respective indications. Consequently, treatment selection is increasingly driven by differences in toxicity profiles rather than antitumor effectiveness. Bleomycin exposure distinguishes BEP from other cisplatin-based regimens and underlies its distinct spectrum of adverse effects. Among these, pulmonary toxicity is the most clinically consequential and potentially irreversible complication. Bleomycin-induced pulmonary toxicity is characterized by marked interindividual variability, clinically significant toxicity occurring even at relatively low cumulative exposure despite cumulative dose remaining an important risk factor, and clinically meaningful morbidity and mortality in a predominantly young and otherwise curable population. Accumulating evidence indicates that bleomycin lung injury represents an immune-mediated process driven by dysregulated alveolar-immune crosstalk, innate immune activation, and profibrotic signaling. This review provides a toxicity-focused comparison of standard first-line cisplatin-based regimens used in the curative treatment of metastatic GCTs, particularly BEP, EP, and VIP regimens within the framework of the International Germ Cell Cancer Collaborative Group (IGCCCG) risk stratification and repositions bleomycin pulmonary toxicity as a model of immune-mediated chemotherapy toxicity. We integrate clinical and experimental data on immunopathogenesis and discuss emerging biomarkers of alveolar injury and immune activation, as promising investigational tools that require prospective validation before routine implementation in first-line treatment selection or pulmonary toxicity monitoring.
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