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The extra's - HELP!

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  • The extra's - HELP!

    I am starting BEP x 3 Monday. I am READY! I can't wait to put this behind me.

    My primary oncologist is based out of KU medical center in Overland Park, Kansas. Because I live 2.5 hours away, I have elected to do my chemotherapy treatments in my hometown. Yesterday I met with the overseeing chemotherapy physician in my home town, and he wanted to change a few of the extracurriculars as I like to call them. The BEP chemo plan was the exact same; however, he wanted to alter my nausea medicine as well as give me a nulastav(sp) shot to boost my immune system.

    KU med for nausea wanted to prescribe: compozine and zofran.
    Hometown oncologist: Zofran, Emnd, Steroid, and Aloxi.

    Has anyone experimented with any of the drugs my hometown oncologist wants to prescribe? What does your oncologist do for nausea?

    In addition, my KU oncologist said that this is a very aggressive form of chemotherapy, whereas my hometown oncologist said it's a piece of cake, and I will have no issues. Thoughts?
    May 6 - R/O Left Testicle
    Pathology Report - Mixed Germ Cell Tumor - Non-Seminoma
    80% Embryonal 20% Yolk Sac
    Margin Free, No LVI.
    Tumor Markers - Normal
    Stage 1A - On Surveillance

    September CT Scan showed 2 Para-Aortic enlarged lymph nodes measuring 1.6cm and 1.3cm
    Restaged 2A
    9/26 Started BEP x 3
    11/21 Ended BEP x 3
    11/21 On Surveillance Again - Lymph Nodes on post chemotherapy scan were 9mm and are expected to shrink further. Merry Christmas to me!!

  • #2
    Neulasta is a good idea, should decrease the chance for neutropenia and allow you to get your treatments on time / reduce the risk of infection.

    Those drugs should be good, had very similar ones. Don't know about the laws where you live, but cannabis is also good to have.

    Wouldn't call BEP a piece of cake... it will probably not be easy, but that's just temporary.


    • #3
      Emend is great and well worth it - sounds like your hometown doc is fairly clued up.

      - T
      30 Jul 14: Discovered lump
      31 Jul 14: GP referral to specialist
      4 Aug 14: Clinical diagnosis of tumour, blood samples taken, CT scans, USS (confirming ~2cm tumour)
      8 Aug 14: Left radical orchidectomy (plus test results back: CT normal, no mets; blood markers slightly elevated: AFP 14.16, HCG 4.9, LDH 149)
      29 Aug 14: Pathology results: Stage 1A Mixed Non-Seminomatous Germ Cell Tumour (composition: Yolk-sac Tumour and Mature Teratoma)

      24 Sep 14: Started precautionary adjuvant 1xBEP
      23 Oct 14: All clear; on surveillance


      • #4
        My son had ondansetron (Zofran) and steroids, and had zero nausea through 3xBEP. Results really do vary by patient though. I'd try to avoid compazine if possible. It's an old school antipsychotic that comes with a pretty high risk of nasty side effects. Same for metoclopramide. There are Zofran alternatives to consider if you're paying for it yourself (super expensive). Mirtazapine and Olanzapine are both pretty potent 5HT3 receptor antagonists (that's how Zofran works), but they're both generic so nobody's promoting them for nausea. They're also more sedating than Zofran.


        • #5
          I wouldn't say I "experimented" with the drugs you listed - but all of these drugs were part of my chemo regimen (4xEP). Steroids (dexamethasone), Emend, Aloxi were all administered via IV prior to EP during each cycle throughout the week (rotated/a different drug on M, W, F - if I remember correctly) - Emend (IMO) was the best of the bunch; although I was close a few nights - I never puked on any cycle. For home use during the off-weeks I was given Zofran and Compazine. I found the Compazine made me dizzy and also screwed with my sleeping, so I did my best not to take it unless I absolutely thought I had to. I stuck with the Zofran which worked better for me. I don't think any chemo is a "piece of cake" - it is miserable for most (i.e. - physical, emotional, psychological) - some worse/some not as bad - but you'll get through it, be cured, and getting back to "normal" within a few months after.

          For what it's worth - other "extra's" that made my life better during chemo for the issues I had were the following:
          -Miralax (as well as milk of magnesia): never in my life would I have dreamed of needing either or these; not sure if it was the steroids or the chemo but I suddenly had problems (which was miserable) and this stuff bailed me out
          -Zantac/Tums: had amazingly bad heartburn (never before, never after) during chemo especially in the off-weeks of the later cycles - both of these helped
          -Claritin: I had the neulasta shot after each cycle and was lucky enough to get the "bone pain" - it was 10/10 painful the first time; I took the Claritin prior to getting the neulasta in later cycles - minimal or no bone pain issues (some people don't get this side effect at all)

          Wishing you the best.


          • #6

            1) For nausea, no compromise : take your hometown oncologist recipe. It's better preventing nausea than treating them. Personnally, I had Zofran + corticosteroid + Emend. Compazine or metoclopramide as needed but they never worked. In my 3rd cycle, I add olanzapine, which alleviates my nausea drastically. Instead of having 7 days of delayed nausea, I only had 2 and it was about 10 % of the intensity. Really, olanzapine worked well for me. Here is a major publication in the field of nausea due to highly emetic chemo, as BEP is :

            2) There was a fear of increasing the risk of pulmonary toxicity of bleomycin with the administration of Neupogen/Neulasta, but there was no correlation when we checked out for this in our institution. I had no shot during my BEP. But it's a reasonable approach to consider.

            3) Finally, BEP x 3 isn't a walk in a park. Each person responds differently to chemo, but BEP x 3 is pretty rough. It's one of the most powerful chemo protocol we give in our clinics, but also one of the most effective. Still, you will pass through this as many have done also here.

            4) Agree with Bexler for Miralax and Zantac (and Claritin if you have Neulasta). It helped me a lot !

            Hope that helps and I'm wishing you good luck with your chemo,

            Don't hesitate if you have problems during your chemo, we're here to help.

            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.


            • #7
              Agree with others. If you are getting neulasta, you should ask about Claritin (not Claratin D, by the way). No one told me about this during the first cycle and I was in serious pain. Took it during cycles 2-4 and didn't have any pain.

              Also agree about the heartburn. No one warned me about this and it was so debilitating I called the emergency line in the middle of the night. I had to experiment with several over the counter anti-acids until I found that Pepcid worked with double the dose (with doctor approval).

              Be prepared to ask for lidocain for mouth soars.

              3X BEP or 4X EP is not a cake-walk. But it is manageable and it will almost certainly cure you. Tell your nurses everything: most likely they can fix it (e.g who would have thought that Claritin would be a magic fix for searing back/hip pain) and something that seems minor to you, and would be minor at any other time in your life, can be very serious.