Background: A prior single arm phase 2 trial of TIP in intermediate- and poor-risk GCT found superior rates of response, progression-free survival (PFS), and overall survival (OS) compared to historical controls with BEP (JCO 34:21, 2016) leading to this randomized phase 2 study of TIP vs. BEP conducted across 7 centers. Methods: From 7/2013 to 7/2017, pts age ≥18 with untreated, IGCCCG intermediate- (LDH modified to ≥3x upper limit of normal) or poor-risk GCT were randomized to 4 cycles of TIP (paclitaxel 120mg/m² days 1-2; ifosfamide 1200mg/m² days 1-5; and cisplatin 20mg/m² days 1-5) or standard BEP. Prophylactic G-CSF was given to both arms whereas levofloxacin was optional but encouraged for TIP pts. The primary endpoint was the 6-month favorable response rate (CR + PR-negative markers). With alpha of 0.1, a sample size of 88 pts had 80% power to detect a one-sided increase in 6-month favorable response rate from 65% with BEP to 85% with TIP. PFS, OS, and biologic correlates including next generation sequencing (NGS) were secondary endpoints. Results: Of 91 eligible pts (n = 45 TIP, n = 46 BEP), 81 had nonseminoma,10 had seminoma; 37 had intermediate-risk and 54 poor-risk. Primary site was testis in 69, mediastinum in 19, and retroperitoneum in 3. 86 pts (TIP: n = 42; BEP; n = 44) were evaluable for 6-month favorable response with no difference between the two arms overall (76% for TIP vs. 73% for BEP) or among intermediate- (100% vs. 88%) or poor-risk (57% vs. 63%) pts. With median follow-up of 1.71 years, estimated 1-year PFS was 72% for both arms (Table). Toxicity and biologic correlate data including NGS will be presented at the meeting. Conclusions: First-line TIP did not improve but had a similar 6-month favorable response rate as BEP among pts with intermediate- or poor-risk GCT. TIP could represent an alternative to BEP for pts with a contraindication to bleomycin. Clinical trial information: NCT01873326