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A Hypothetical: BEPx3 Twice in One Lifetime?

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  • A Hypothetical: BEPx3 Twice in One Lifetime?

    Let's say someone had TC in their right testicle, went through BEPx3, and was cured.
    Years later they develop a second cancer in their left testicle and surveillance/RPLND isn't an option. Can they go through BEPx3 again, or would they have to take the route of VIP, TIP, etc.?

  • #2
    Yes, in the case of a new primary, BEP is on the table. If it is a *new primary* the cancer has not seen chemo before, and will not have developed any resistances to it.
    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!
    9/27/2018 all clears up to this date!

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    • #3
      My understanding is that there is a limit to the amount of bleomycin a human can receive in their lifetime (400 units, equivalent to the amount of bleomycin in 4x BEP).

      Therefore, if you had already completed 3x BEP and received 300 units, I do not believe you would be eligible for another 300 units hence increasing your lifetime dose to 600 units.

      I am not an expert, so happy to be corrected. But that is my understanding.

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      • #4
        This post is the same question I have always wondered about.

        Yes, I've also heard about the lifetime max. for Bleo.

        I suppose in this scenario one could do 1xBEP followed by 3xEP once the Bleo. lifetime max has been met.

        - 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
        July 10th 2018: 4 YEARS ALL CLEAR !

        Comment


        • #5
          lifetime recommended max for etoposide is what is in 4xEP or 4xBEP too I think? but you still get etoposide in second line treatment. I'm guessing the theory is that even though you increase your liklihood of secondary cancers, the chances of that are still low as compared to the nearly 100% chance of death due to cancer if you do not treat the current cancer with effective drugs.
          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!
          9/27/2018 all clears up to this date!

          Comment


          • #6
            If it's Stage 2 seminoma, it's also possible to get radiation treatment as opposed to chemo, plus RPLND is an option for non-seminoma.
            July 2016 - Left I/O
            December 2016 - BEPx3
            All clear for 1 year!

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