If Bleo affects lung function, what to do?

[highland850]

SIL has a lung function test today-just finished first cycle, 2 to go. His original test showed his lung function to be on the lower side of normal. If today's test shows impaired function, will they delay chemo a week, or should they just go to EP ? Then what would happen following that-add an extra cycle or a BP at the end? I'm a little nervous that his onc. seems to want to do this slowly-as in he originally wanted to give a break b/w 1st and 2nd cycle, but they told him no. Now if lung function becomes the issue, I'm thinking he (onc) will want the break.

[Rudachenko]

Yes bleo has effect on lungs.I had pneumonia because it.

[bexler]

Yes, a possible side effect of bleomycin is pulmonary toxicity/damage of lung tissue. If lung function is impaired/doctors are concerned about bleo toxicity I believe the likely course of action will be to finish the remainder chemo out as 3xEP (i.e. - add an extra cycle of EP) in addition to the 1st round he's already completed for a total of 4 cycles (1xBEP + 3xEP). Given the effectiveness of the chemo protocol, I believe there are very few scenarios where it would be recommended for chemo to be discontinued or postponed. With EP only, there would be a week (5 days of EP) chemo, then 2 weeks off -- repeat 3 more times. In that scenario (finish with 3xEP), no more bleo would be given so he would essentially have a 2 week break in between each week of chemo. I’m sure others will chime in with their thoughts/experience. Sounds like the Onc. will need to provide him with some additional clarity on the future course of action.

[biwi]

I would not want to skip or delay any cycle. Assuming you were scheduled for 3xBEP, if lung function were an issue I'd request to switch to 4xEP instead of 3xBEP and continue with treatment on schedule. Obviously I am OK with that because I chose 4xEP over 3xBEP in the first place.

[highland850]

OK, the good news is...for now all is well! So cycle 2 begins in 4 days, as planned. Thanks for the info-I thought as much, but wanted to have the info in case we need it.

[EdOneBall]

They won't stop BEP unless there is a risk of life-threatening lung damage, although some damage is to be expected. Stopping chemo mid-treatment is very dangerous, because it gives the tumor a chance to develop resistance.

If a severe lung reaction to the BEP develops, they'll immediately switch to EP and give an additional round.

[Davepet]

although some damage is to be expected.

Hmmm, I believe the vast majority have no permanent lung damage after bleo.

Dave

[Mike]

although some damage is to be expected.

Disclosure in that I have not been able to pull the full-text article to read it yet (I lost my remote medical library access which stinks) but this is in press now and looks like about 10% of guys receiving bleomycin for testis cancer had some level of pulmonary toxicity. http://www.clinical-genitourinary-ca...255-5/abstract At least it gives somewhat of a perspective.

Mike

[Davepet]

That is actually higher than I thought, but still fairly low.

[EdOneBall]

I didn't know the exact probabilities, but my oncologist warned me that it's common especially as I received 4xBEP.

10% is common, but still good odds.

[highland850]

Hey guys, update and still need help! SIL began 3rd cycle yesterday. He completed 2XBEP, but Dr. changed it yesterday to EP due to lung function that he felt was getting dangerous. OK, we get it. Since he has no Bleo this 5 day cycle and loses the 2 one day bleo, isn't he supposed to have an extra EP? Maybe I don't understand it correctly. Dr. wants to end chemo here-2xbep and 1xEP, b/c SIL also has tinnitus from the cisplatin. He feels confident that the CT scan will show nothing, and no further need for treatment. Would he be at higher risk for recurrence?

[Davepet]

I am not a doctor. My guess is that missing 3 doses of bleo is unlikely to affect the overall outcome, but I really don't know for sure. You mightt want to email Dr E to see what he thinks.

[Mike]

I would have your doctor chat with Dr. Einhorn at Indiana University as Dave mentioned. I have seen old data http://ascopubs.org/doi/abs/10.1200/jco.1995.13.2.470 (which is from 1995 and published by Dr. Einhorn) suggesting that the bleomycin was necessary and then there was a recent abstract looking at 3 cycles of EP (although the dose was a little different. http://meetinglibrary.asco.org/content/170099-176

Having someone like Dr. Einhorn that is intimately aware of any publications out there, give his input, would be incredibly valuable to me if I was deciding what to do for myself.

Mike

[highland850]

thanks guys. We did email Einhorn, and he felt that the onc. was making the right decision in this case, b/c there was no invasion and he had halready had most of the bleo. We'll find out, I guess. Can't go further risking lung damage or deafness.

[Mike]

Thanks for the info from Dr. Einhorn. It is always good to hear what he recommends in the different situations.

Mike