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Anyone ever have to do 3xBEP twice?

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  • Anyone ever have to do 3xBEP twice?

    I'm wondering if anyone has had to go through BEP twice. From what my Dana Farber oncologist has told me, if it is a new cancer (not a recurrence of the first) in the contralateral testicle that happens down the road, the same treatment regimen can be used a second time.

  • #2
    I've not read about anyone who has done it, and I always thought you can't have the same protocol twice but it might not be the case.

    I guess, hopefully, with the amount of surveillance and awareness of symptoms that previous TC survivors have, that if it happened in the other testicle it would be caught early enough to get away with minimal treatment. Hopefully anyway!
    24 year old diagnosed 6/11/16
    Pre/o markers 9/11/16 - HCG 15, AFP 210, LDH 539
    Pre/o CT Clear
    Non-seminoma (80% embryonal carcinoma, 10% yolk sac tumour, 5% chorea carcinoma, 5% seminoma)
    Post-op markers - 14/12/16 - HCG 35, AFP 1050, LDH 430
    Post-op CT with one enlarged lymph node - 1.5x1cm
    Borderline stage 2B/3B
    BEPx3 started 15/12/16 (Borderline BEPx4 - Advise of Dr. E to only do 3 rounds)
    CT and markers clear - in remission - 28/2/16

    Comment


    • #3
      Hard to say if that's true or not. I never did any self-checks, and went to the doctor about a week and a half after I started seeing my testicle visibly enlarged. The pathology showed that there was no penetration of the tunica or epididymis, tumor clear of margins, etc, and I was already at stage 2B classical seminoma. My oncologist said the cancer can start spreading before it even grows locally, so who knows if I could have caught it or noticed something early.

      Comment


      • #4
        Originally posted by BenG1980 View Post
        Hard to say if that's true or not. I never did any self-checks, and went to the doctor about a week and a half after I started seeing my testicle visibly enlarged. The pathology showed that there was no penetration of the tunica or epididymis, tumor clear of margins, etc, and I was already at stage 2B classical seminoma. My oncologist said the cancer can start spreading before it even grows locally, so who knows if I could have caught it or noticed something early.
        There may have been a small lump or enlargement a few months beforehand which you never noticed potentially until it got to the stage where it was visibly large, but yeah I know what you mean, in some cases it is hard to tell. I never used to check regularly, maybe once every few months in the shower, but now the start of every month I do a couple checks. I am guessing as I am 25 now, if a second tumor occured it may be seminoma so it could be a different route, but this is all ifs and buts.

        I know you're on your BEP now but this is something you shouldn't worry too much about, just check every month and you should be fine and IF anything happened catch it early.
        24 year old diagnosed 6/11/16
        Pre/o markers 9/11/16 - HCG 15, AFP 210, LDH 539
        Pre/o CT Clear
        Non-seminoma (80% embryonal carcinoma, 10% yolk sac tumour, 5% chorea carcinoma, 5% seminoma)
        Post-op markers - 14/12/16 - HCG 35, AFP 1050, LDH 430
        Post-op CT with one enlarged lymph node - 1.5x1cm
        Borderline stage 2B/3B
        BEPx3 started 15/12/16 (Borderline BEPx4 - Advise of Dr. E to only do 3 rounds)
        CT and markers clear - in remission - 28/2/16

        Comment


        • #5
          That's an interesting question because from what I understand is that there is a lifetime max dosage of Bleomycin and it's not a good idea of going over that max. I think that dosage is 360 units. In 3XBEP you will get 270 units in total...or 30 units in each bag. So 4XBEP will put you right at the 360 unit mark.

          I doubt there is such a "max" for cisplatin or etoposide,.

          If anyone can provide further details to this question that would be great.

          I suppose instead of a
          3XBEP one could do 4XEP.

          - Matt
          March 4th 2014: [AFP = 2.5; bHCG = 6; LDH = 618]
          March 13th: Left IO 100% Classic Seminoma
          6.3 x 5.1 x 3.8 cm, no invasion of anything
          LDH never fully normalized
          Stage: IS
          Watchful Waiting
          May 1st: promoted to Stage IIB with two PET active tumors in the para-aortic lymph nodes 2.5 & 2.4 cm
          May 12th: started 3xBEP
          Neupogen during Cycle 2 and 3
          July 8th: Last Bleo shot of Cycle 3 -- chemo completed !
          August 4th: Post Chemo CT/PET scan
          September 4th: Port removed
          January 11th 2017: 2 & 1/2 YEARS ALL CLEAR !

          Comment


          • #6
            Matt,

            That's an interesting point about the Bleo. I'll mention that at some point to my oncologist. Hopefully neither of us will ever need to know the answer to that question!!

            Comment


            • #7
              There is also a max cumulative dose for etoposide as well before leukemia is a real possibility.
              6/5/15: bHCG 27,AFP 8.66, LDH 361, 5.6cm lymph node - Stage IIC
              6/16/15: Left I/O 85% EC, 10% chorio, 5% yolk sac opinion 2 (mayo) 90% EC, 10% yolk sac
              7/7/15: bHCG 56, AFP 42, LDH 322
              7/13/15 - 9/18/15: 4xEP
              10/1/15: bloodwork normal, ct scan shows 2 lymph nodes 1.0cm
              10/26/15: 2nd opinion on CT results - lymph nodes normal. Surveillance!
              4/6/16: 1.7cm X 1.5cm lymph node found with markers normal.
              4/20/16: RPLND @ IU - teratoma only!
              5/10/17 all clears up to this date!

              Comment


              • #8
                Are you seeing Dr. Christopher Sweeney at Dana Farber? If so, he certainly knows testis cancer but you may want to ask about the bleomycin issue. You can always get second opinions as well.

                Mike
                Oct. 2005 felt lump but waited over 7 months.
                06.15.06 "You have Cancer"
                06.26.06 Left I/O
                06.29.06 Personal Cancer Diagnosis Date: Got my own pathology report from medical records.
                06.30.06 It's Official - Stage I Seminoma
                Surveillance...
                Founded the Testicular Cancer Society
                6.29.13 Summited Mt. Kilimanjaro for 7th Cancerversary

                Comment


                • #9
                  Hi Mike,

                  No, I'm seeing Dr. Mark Pomerantz, he is also a specialist in the subject. He was the one who I mentioned it to, so I was curious if anyone had gone through it.

                  Comment


                  • #10
                    TC is a very rare cancer.Getting kit twice is extremely rare. While I'm sure there are a few who have needed chemo twice for two primaries,I can't recall any who have posted here about it.I'm thinking this will be much more common in the years ahead as more of us survive long term after TC1.

                    Dave
                    Jan, 1975: Right I/O, followed by RPLND
                    Dec, 2009: Left I/O, followed by 3xBEP

                    Comment


                    • #11
                      From what I am understanding, and I asked a top testis cancer expert, is that BEP a second time really would not be the best option. If it was me, I would have a conversation with Dr. Pomerantz and see if your case can be presented and/or get a second opinion from Dr. Sweeney if you are at Dana-Farber already.

                      MIke
                      Oct. 2005 felt lump but waited over 7 months.
                      06.15.06 "You have Cancer"
                      06.26.06 Left I/O
                      06.29.06 Personal Cancer Diagnosis Date: Got my own pathology report from medical records.
                      06.30.06 It's Official - Stage I Seminoma
                      Surveillance...
                      Founded the Testicular Cancer Society
                      6.29.13 Summited Mt. Kilimanjaro for 7th Cancerversary

                      Comment


                      • #12
                        Hi Mike,

                        I don't have a second testicular cancer, I am currently on my third cycle of BEP for my first (and hopefully only) run with this disease. But thanks for Dr. Sweeney's name, I'll try to remember that if the day ever comes.

                        Ben

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