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  • A layman's primer on TC chemo

    Over the last several weeks, I have put together a primer on the chemo agents that are used in the treatment of testicular cancer. This primer is aimed at explaining why certain side effects occur while delving a little bit into the biological aspects of their function. In a sense, I want to showcase a little bit of the science while trying to serve as a guide to guys undergoing BEP treatment.

    One of the wonders of the WWW is the ability to edit things promptly. If there are terms that don't make sense, or if you find any errors or confusing terms, let me know so I can look into the issue swiftly.

    Finally, I want to acknowledge the other mods for their help with this. My fellow geek Karen helped bring me down to earth with the jargon, and Scott and Bill made contributions to its readability to the non-scientist.

    The primer can be found here. I hope you find it useful.
    "Life moves pretty fast; if you don't stop and look around once in a while, you could miss it." -Ferris Bueller
    11.22.06 -Dx the day before Thanksgiving
    12.09.06 -Rt I/O; 100% seminoma, multifocal; Stage I-A; Surveillance; Six years out! I consider myself cured.


  • #2
    Well done Fed.
    As a layman and a patient, I can tell you my chemo experience was not a walk in the park.
    In fact, I am still slightly anemic- even now ten months post chemo. This is something that my doc watches. Makes me that much prouder of my 40 miles!

    I do have a question for you:

    Did your research uncover the factors that determine the actual dosages prescribed? Is it possible that a less experienced facility may over infuse a patient, when following standard protocals? In other words, infuse more chemo than actually necessary.
    Stage III. Embryonal Carcinoma, Mature Teratoma, Choriocarcinoma.
    Diagnosed 4/19/06, Right I/O 4/21/06, RPLND 6/21/06, 4xEP, All Clear 1/29/07, RPLND Incisional Hernia Surgery 11/24/08, Hydrocelectomy and Vasectomy 11/23/09.

    Please see a physician for medical advice!

    My 2013 LiveSTRONG Site
    The 2013 Already Balders

    Comment


    • #3
      Fed,

      Great job with keeping it understandable. I work with a number of researchers and they typically have great dificulty communicating in laymans terms.
      Does the XRT and carboplatinum also work by disrupting the DNA?
      DX Feb.08, Right IO feb. 08, Seminoma, RT March 08, all clear to date.

      Comment


      • #4
        Originally posted by John S
        Does the XRT and carboplatinum also work by disrupting the DNA?
        Carboplatin works exactly like cisplatin, the difference being that carboplatin binds to DNA a bit more weakly than cisplatin. Because of the weaker binding, carboplatin is not as potent as cisplatin, but as a consequence, it produces fewer side effects, a trait that makes it attractive for use in high dose regimens.

        XRT causes damage to DNA, especially when cells are dividing. All cells have a signaling system that detects damage to DNA and instructs the cell to fix it. If the damage is too overwhelming, the same signaling system instructs the cell to self-destruct. Coincidentally, my research involves finding ways to control this signaling system when it's defective (about 50% of all cancer cells have these problems).
        "Life moves pretty fast; if you don't stop and look around once in a while, you could miss it." -Ferris Bueller
        11.22.06 -Dx the day before Thanksgiving
        12.09.06 -Rt I/O; 100% seminoma, multifocal; Stage I-A; Surveillance; Six years out! I consider myself cured.

        Comment


        • #5
          Fed,
          Do you know about the high dose chemos?? Like Vinorelbine (Navelbine) and Ifosfamide ?That is what Jay is currently getting along with Cisplatin. Is it the standard VIP for salvage chemo?? He is also getting Mesna and all the counteractive meds they give him. Because of one of the drugs he is getting shots of insulin. He has three today. I am worried about what might happen when he is home alone with our son during Nadir and I am at work. I am already making sure that Chris knows to dial 911 and give our address. I am also trying to find a place to learn CPR. I also need to find a support group for our son that has kids going through similar things. He couldn't sleep last night worrying about dad.
          Diagnosed Mixed Germ Cell tumor Carcinoma and classic seminoma StageIIC 6*8cmbulky June 26-08
          Left I/O June 26-08 4*BEP July-08-Sept-08
          Mets to Abdomin/chest,
          Stage III, , 6*8 cm Jul 08
          Markers normalized Nov08, residual tumor 3*2cm in abd. 13mm in chest. Spinal Stenosis,Neuropathy RPLND feb 09
          Found all three: Cancer, teratoma and scar tissue
          10/09 B-HCG up to 39.90, recurrent TC, 2*VIP 12/09, TI started 05/11/2010, stem cell infusion 5/18/2010 day of rebirth
          08/10 all clear

          Comment


          • #6
            Originally posted by starjayroman View Post
            Do you know about the high dose chemos??
            There are two types of HDC regimens. One is carboplatin and etoposide given at 7-10 times the regular doses. The second consist of two phases: an induction with taxol and ifosfamide/mesna followed by consolidation with carboplatin and etoposide given at 4-6 times the regular doses.
            Originally posted by starjayroman View Post
            Like Vinorelbine (Navelbine) and Ifosfamide ?That is what Jay is currently getting along with Cisplatin. Is it the standard VIP for salvage chemo?? He is also getting Mesna and all the counteractive meds they give him.
            Typically, salvage regimens use vinblastine, ifosfamide and platinum (VeIP) or taxol, ifosfamide and platinum (TIP). VIP is now considered a first-line treatment for patients that could show toxicity to bleomycin.
            Originally posted by starjayroman View Post
            I am worried about what might happen when he is home alone with our son during Nadir and I am at work. I am already making sure that Chris knows to dial 911 and give our address. I am also trying to find a place to learn CPR. I also need to find a support group for our son that has kids going through similar things. He couldn't sleep last night worrying about dad.
            Great call on giving instructions to your son. The burden cancer has on kids of patients is evident at all ages, and that is a difficult struggle. Perhaps your local cancer center has information on support groups for kids (I know we have them at Dana-Farber).
            "Life moves pretty fast; if you don't stop and look around once in a while, you could miss it." -Ferris Bueller
            11.22.06 -Dx the day before Thanksgiving
            12.09.06 -Rt I/O; 100% seminoma, multifocal; Stage I-A; Surveillance; Six years out! I consider myself cured.

            Comment


            • #7
              Originally posted by Fed View Post
              Coincidentally, my research involves finding ways to control this signaling system when it's defective (about 50% of all cancer cells have these problems).
              Fed - do you work on p53? Just reading this 'sticky' thread and saw your reference to controlling apoptosis vs proliferation and thought it sounded like it ...

              Best wishes,
              Tracy
              Tracy
              Cancer pharmacologist, caregiver blog here

              Wife to Kel, dx 12/30/11 Stage IIIc (poor) embyronal, AFP 13700, 10x11 cm retroperitoneal mass, 1 cm^2 lung met
              Left I/O 12/31/10.
              4xBEP 1-4/11, AFP=22, 5*7 RP mass, tx failed
              1.5 x VeIP 5-6/11; tx failed, AFP/b-hCG rising
              Salvage RPLND @Indy 6/29/11, metastatic mixed germ cell tumor with yolk sac, seminoma and teratoma
              Remission! AFP steady since 9/2011; 2+ years ALL CLEAR

              Comment


              • #8
                Originally posted by CancerSux View Post
                Fed - do you work on p53? Just reading this 'sticky' thread and saw your reference to controlling apoptosis vs proliferation and thought it sounded like it ...
                Bingo! My lab researches chemical methods of modulating protein-protein interactions, and reactivation of p53 function is the centerpiece of my group's work.
                "Life moves pretty fast; if you don't stop and look around once in a while, you could miss it." -Ferris Bueller
                11.22.06 -Dx the day before Thanksgiving
                12.09.06 -Rt I/O; 100% seminoma, multifocal; Stage I-A; Surveillance; Six years out! I consider myself cured.

                Comment


                • #9
                  Originally posted by Fed View Post
                  Bingo! My lab researches chemical methods of modulating protein-protein interactions, and reactivation of p53 function is the centerpiece of my group's work.
                  Nice! That is what I thought by the description.

                  My lab focuses on secondary DNA structures induced by supercoiling and using them as druggable targets for oncogenes - mostly for MYC ... kind of pharmacology and chemical (structural really) biology combined.
                  Tracy
                  Cancer pharmacologist, caregiver blog here

                  Wife to Kel, dx 12/30/11 Stage IIIc (poor) embyronal, AFP 13700, 10x11 cm retroperitoneal mass, 1 cm^2 lung met
                  Left I/O 12/31/10.
                  4xBEP 1-4/11, AFP=22, 5*7 RP mass, tx failed
                  1.5 x VeIP 5-6/11; tx failed, AFP/b-hCG rising
                  Salvage RPLND @Indy 6/29/11, metastatic mixed germ cell tumor with yolk sac, seminoma and teratoma
                  Remission! AFP steady since 9/2011; 2+ years ALL CLEAR

                  Comment


                  • #10
                    Hi Trace & Fed,

                    I have a friend who's an MD and is interested in transitioning into a research type roll. Just wondering what paths you took (academic or otherwise) to get into your respective careers? Any thoughts on how a general practitioner could get into your field?

                    Thanks!
                    Husband Shaun diagnosed March 2010. AFP 4571, HCG 3340.
                    6cm x 6cm x 8cm retroperitoneal mass + 1cm nodule in right lung.
                    Stage IIIb, Intermediate Risk.
                    Left I/O March 9/10: 75% EC, 20% Teratoma, 5% Yolk Sac + Seminoma.
                    3xBEP + 1xEP March 15 - May 21/10: markers normal.
                    Bilateral RPLND July 28/10: 9.5 x 7 x 4.5cm mass, teratoma only.
                    Chylous Ascites Aug/Sep.
                    November 2012 All Clear
                    Continuously monitoring 0.9 x 1.7cm omental nodule (possible fat necrosis)

                    www.teamshaun.wordpress.com

                    Comment


                    • #11
                      Jules,

                      We are on the road to MS right now, but I will send you a PM when we get into Texas tonight at our first stop about it ... IMO, MDs can transition into research pretty well...

                      Tracy
                      Tracy
                      Cancer pharmacologist, caregiver blog here

                      Wife to Kel, dx 12/30/11 Stage IIIc (poor) embyronal, AFP 13700, 10x11 cm retroperitoneal mass, 1 cm^2 lung met
                      Left I/O 12/31/10.
                      4xBEP 1-4/11, AFP=22, 5*7 RP mass, tx failed
                      1.5 x VeIP 5-6/11; tx failed, AFP/b-hCG rising
                      Salvage RPLND @Indy 6/29/11, metastatic mixed germ cell tumor with yolk sac, seminoma and teratoma
                      Remission! AFP steady since 9/2011; 2+ years ALL CLEAR

                      Comment


                      • #12
                        Thanks Tracy - glad to hear you're all packed up and on the move. I'll look forward to hearing an update. Good luck
                        Husband Shaun diagnosed March 2010. AFP 4571, HCG 3340.
                        6cm x 6cm x 8cm retroperitoneal mass + 1cm nodule in right lung.
                        Stage IIIb, Intermediate Risk.
                        Left I/O March 9/10: 75% EC, 20% Teratoma, 5% Yolk Sac + Seminoma.
                        3xBEP + 1xEP March 15 - May 21/10: markers normal.
                        Bilateral RPLND July 28/10: 9.5 x 7 x 4.5cm mass, teratoma only.
                        Chylous Ascites Aug/Sep.
                        November 2012 All Clear
                        Continuously monitoring 0.9 x 1.7cm omental nodule (possible fat necrosis)

                        www.teamshaun.wordpress.com

                        Comment


                        • #13
                          link is broken

                          Originally posted by Fed View Post
                          Over the last several weeks, I have put together a primer on the chemo agents that are used in the treatment of testicular cancer. This primer is aimed at explaining why certain side effects occur while delving a little bit into the biological aspects of their function. In a sense, I want to showcase a little bit of the science while trying to serve as a guide to guys undergoing BEP treatment.

                          One of the wonders of the WWW is the ability to edit things promptly. If there are terms that don't make sense, or if you find any errors or confusing terms, let me know so I can look into the issue swiftly.

                          Finally, I want to acknowledge the other mods for their help with this. My fellow geek Karen helped bring me down to earth with the jargon, and Scott and Bill made contributions to its readability to the non-scientist.

                          The primer can be found here. I hope you find it useful.
                          Hey, did you put this on a new site? I'm trying to access it but the link seems to be broken. Thanks!
                          Kaylee, girlfriend of Sean
                          12.29.13 - removed left testicle
                          1.17.14 - diagnosed with sIII TC
                          choriocarcinoma & teratoma
                          nodules in lungs & abdomen
                          1.27.14 - first round of 4xBEP
                          ***** 2.24.14 going to see Dr. Einhorn!!!!! *****

                          Comment


                          • #14
                            Originally posted by kaylee View Post
                            Hey, did you put this on a new site? I'm trying to access it but the link seems to be broken. Thanks!
                            The link is 8 years old. I am not surprised it is gone
                            Heidi

                            Husband - age 51
                            10/20/10 - Primary mediastinal seminoma - 10 x 9.3 cm; -HCG = 33 (<2.6); AFP = 3.5 (<9); LDH = 274 (100-200 )
                            11/1/10 4X BEP
                            12/7/10 End Cycle 2 - -HCG = 2; AFP = 4.6; LDH = 139 ; 4XBEP changed to 3 as tumor now 2.1 x 3.7 cm
                            2/15/11 - Post-chemo PET ; residual 8 mm x 2 cm
                            6/29/11 - Lung nodules stable or smaller, chest mass continues to shrink & markers all normal
                            Surveillance since 6/11

                            Comment


                            • #15
                              I'll ask Fed if he still has it.

                              T
                              Tracy
                              Cancer pharmacologist, caregiver blog here

                              Wife to Kel, dx 12/30/11 Stage IIIc (poor) embyronal, AFP 13700, 10x11 cm retroperitoneal mass, 1 cm^2 lung met
                              Left I/O 12/31/10.
                              4xBEP 1-4/11, AFP=22, 5*7 RP mass, tx failed
                              1.5 x VeIP 5-6/11; tx failed, AFP/b-hCG rising
                              Salvage RPLND @Indy 6/29/11, metastatic mixed germ cell tumor with yolk sac, seminoma and teratoma
                              Remission! AFP steady since 9/2011; 2+ years ALL CLEAR

                              Comment

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