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BEP v EP

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  • BEP v EP

    I wonder if I can ask some opinions, particularly from those who have been through BEP x 3 and EP x 4
    I saw another oncologist today and was rather disheartened when he came out strongly in favour of EP as in his 30 year history he had seen more pulmonary fibrosis cases than not and that he felt it wasn't worth the risk of permanent damage in patient who otherwise may live a long life.

    I am aware that the sides are split (IU v SK etc) and many papers are conflicting. EP runs the risk (though small) of Leukemia and more PN and Tinnitus but BP has this potentiality for Pulmonary fibrosis. (PF)

    I wonder if any posters would mind sharing their personal experience. Has anyone has 3BEP and experienced PF. What is it like? I am having trouble imagining what it would mean in reality.

    Thanks in advance from any posters

  • #2
    This is an interesting topic. Most major cancer institutions around the world go with 3 x BEP. However, MSK goes with 4 x EP and they are one of the best in the world. Both have their pros and cons.
    Diagnosed at age 31. Treated in NYC. Now living in Ottawa, ON, Canada.

    7/1/2015: felt tiny lump on side of R testicle
    7/30/2015: Ultrasound shows 2 intra-testicular masses.
    7/31/2015: tumor markers normal, CXR clear
    8/5/2015: R orchiectomy
    8/11/2015: Pathology: 1.2 x 1.0 x 1.0 cm, embryonal 80%, seminoma 20%, with LVI and rete testis invasion
    8/14/2015: CT abdomen/pelvis clear, Stage 1b
    8/24/2015: started 1 x BEP

    Comment


    • #3
      Yes, I don't think there will be a clear answer. Risk-factor-wise (as I am 43) I fear that I am more at risk from Bleo, but then Again I am a non smoker and lungs are good.
      In some way, I fear long term Peripheral Neuropathy that might affect my everyday motions more than a degree of pulmonary fibrosis. However, If PF from chemo is anything like the the disease Pulmonary Fibrosis (progressive and life-threatening) then that would change my feeling.

      I am hoping some BEPx 3 graduates will be able to share the NP issues. I remember one poster who underwent 4 x EP (apologies, as I forgot name) who described his PN as quite debilitating and said something like "if I had the chance over again I would do 3 X BEP instead of 4 X EP.

      Comment


      • #4
        I had 3xBEP at age 55 as an ex-smoker (30 years, quit 7 years prior to chemo). I had zero new lung problems despite a lung function test that said I had COPD. The risk of bleo induced lung problems is way overblown, based on reports in this forum, very few have problems. I did end up with some peripheral neuropathy in my fingers. More annoying than debilitating in my case.

        Dave
        Last edited by Davepet; 06-27-16, 03:38 AM.
        Jan, 1975: Right I/O, followed by RPLND
        Dec, 2009: Left I/O, followed by 3xBEP

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        • #5
          Originally posted by spok View Post
          Yes, I don't think there will be a clear answer. Risk-factor-wise (as I am 43) I fear that I am more at risk from Bleo, but then Again I am a non smoker and lungs are good.
          In some way, I fear long term Peripheral Neuropathy that might affect my everyday motions more than a degree of pulmonary fibrosis. However, If PF from chemo is anything like the the disease Pulmonary Fibrosis (progressive and life-threatening) then that would change my feeling.

          I am hoping some BEPx 3 graduates will be able to share the NP issues. I remember one poster who underwent 4 x EP (apologies, as I forgot name) who described his PN as quite debilitating and said something like "if I had the chance over again I would do 3 X BEP instead of 4 X EP.
          I've spent a fair amount of time in the TC community now. I've never seen a debilitating form of bleomycin induced lung injury from 3 x BEP. I have seen bleomycin lung injury before, but not clinically evident disease, and also any lung function deficits are often reversible. I have seen one fatality from Bleomycin lung injury from 4 x BEP on this forum. It is highly recommended to keep Bleomycin levels to less than 300 units as the side effects increase drastically when above these levels. Thankfully, with 3 x BEP, you would get 270 units. I have seen a few cases of Etoposide related leukemia, each one from 4 x EP. One other thing that bothers me about 4 x EP is that yes the peripheral neuropathy will be worse, but the nerves all over the body will be affected. So this can manifest in various ways, including muscle fatigue, weakness, maybe even thermal regulation, etc.
          Diagnosed at age 31. Treated in NYC. Now living in Ottawa, ON, Canada.

          7/1/2015: felt tiny lump on side of R testicle
          7/30/2015: Ultrasound shows 2 intra-testicular masses.
          7/31/2015: tumor markers normal, CXR clear
          8/5/2015: R orchiectomy
          8/11/2015: Pathology: 1.2 x 1.0 x 1.0 cm, embryonal 80%, seminoma 20%, with LVI and rete testis invasion
          8/14/2015: CT abdomen/pelvis clear, Stage 1b
          8/24/2015: started 1 x BEP

          Comment


          • #6
            Agree with RJKD.

            I work as an hospital pharmacist. In my young career (3 years), I've heard about 1 case fatality with bleo and PF. It was in an marijuana and other substances smoker. The actual incidence is about 1 %. Being more than 40 years is a risk factor, but you shouldn't see it to be clear cut since you're 43.

            PN with 400 mg/m2 of cisplatin is very common, as most patients receiving this dose will experiment some degrees of PN, ranging for mild to severe.
            You have raised also the risk of secondary leukemia which reachs about 1 - 2 % with 4 x EP.

            Both have pros and cons. Here are the opinions on the subject of Dr Einhorn, who invented BEP : http://jco.ascopubs.org/content/24/16/2597.full

            Jean-Philippe
            December 15, 2015 : Right I/O. Markers normal.
            December 24, 2015 : Merry Christmas ! 100 % pure EC, no LVI.
            January 7, 2016 : CT scan : 2 RPLN of 8 and 9 mm
            February 2016 : Markers normal.
            March 2016 : Markers normal.
            April 2016 : Abnormal B-HCG (43). 14 mm (from 8) and 10 mm (from 9) lymph nodes.
            April 25, 2016 : Happy birthday ! Relapsed confirmed.
            May 2, 2016 : BEP x 3 begins.
            July 3, 2016 : BEP x 3 ends.
            July 2016 : Serum tumor markers normal. 10 mm (from 14) and 6 mm (from 10) lymph nodes. Back on surveillance !
            December 23, 2016 : Merry Christmas ! Serum tumor markers normal. 6.8 mm (from 10) and no more visible (from 6) lymph nodes. Surveillance continues.
            June 2017 : Serum tumor markers normal. 4 mm (from 7 mm) lymph node. Surveillance continues.

            Comment


            • #7
              thanks to all the responders. Things seem to lean towards BEP.
              Can I check: at 2m squared, I am looking at 40mg x 6 = 240mg is that correct?
              Thanks
              Spok

              Comment


              • #8
                Bleomycin dosage is independant of body surface area in germ cell tumor (as opposed as bleomycin in lymphoma)
                The correct dose is 30 units on day 1, 8 and 15 (or 2, 9 and 16).
                So, with BEP x 3 = 270 units.

                Jean-Philippe
                December 15, 2015 : Right I/O. Markers normal.
                December 24, 2015 : Merry Christmas ! 100 % pure EC, no LVI.
                January 7, 2016 : CT scan : 2 RPLN of 8 and 9 mm
                February 2016 : Markers normal.
                March 2016 : Markers normal.
                April 2016 : Abnormal B-HCG (43). 14 mm (from 8) and 10 mm (from 9) lymph nodes.
                April 25, 2016 : Happy birthday ! Relapsed confirmed.
                May 2, 2016 : BEP x 3 begins.
                July 3, 2016 : BEP x 3 ends.
                July 2016 : Serum tumor markers normal. 10 mm (from 14) and 6 mm (from 10) lymph nodes. Back on surveillance !
                December 23, 2016 : Merry Christmas ! Serum tumor markers normal. 6.8 mm (from 10) and no more visible (from 6) lymph nodes. Surveillance continues.
                June 2017 : Serum tumor markers normal. 4 mm (from 7 mm) lymph node. Surveillance continues.

                Comment

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