Starting 3xBEP Next week

[Ryan Bi]

The same situation as we met. We could start at 3 pm after contact Dr.Einhorn. My son was treated with Neupogen at the end of cycle 2 long week.

Personally, I would continue chemo on Saturday instead of Monday. I would rather try every possibility to get the treatment in time.

Just for your reference.

Best Regards

Amy, Ran’s mumm

[wjonw]

Hi All,

I'm starting Cycle 3 on Monday. At this point, my onc has never suggested to stop the treatment even when my ANC was at .19, nor did he suggests any neupogen. He mentionned this is expected and the counts will fluctuate but that they keep treating unless any emergencies.

I've been fine, just make sure to stay away from crowds and avoid germs. I've still been able to walk around and even go on a small 2m run during the B weeks after i've recovered.

I wonder what makes onc act differently about the ANC and whether to wait or not. Personally i just want to get it over with so i'm fine for them to keep going but i do wonder why some oncs suggest a few day break.

any ideas?

BTW:
29 y.o Stage IIB Pure Seminoma
July 2018 left OI
July 2018 surveillance
Jan 2019 RP node 35mm X 30mm- Restaged from 1b to IIb
Jan 2019 3xBEP

[Goodday]

My anc last week was at a .2<. This was as of February 22nd. Does anyone know when is it too low? I was rather surprised as to how low they got from one week to the next.

[MilanD]

My Anc wad 0.43 I believe on Monday but went to 0.97 on Tuesday and today (Thu) is more than 2.0 . So it is really rollercoaster. I think it will go down in week or two after long week. Most experienced testicular cancer oncologist do not recommend delay treatment or lower dosage unless fever and infection. I got my delayed for a day which was mistake. Now I am getting treatment at hospital on Saturday (hopefully).

[Davepet]

I believe that they delay treatment when the counts go low when treating other types of cancers, they should not do so for TC.

[Goodday]

I finished week 4 this past week. This weekend has been nothing but rest and recovery. Felt the effects more this time around than the first round, but that was expected. It's been a rollercoaster of emotions to say the least. It's been a rough a week but looking to recover this week and next.

[Goodday]

Hi there, today I met with my onc. for a follow-up prior to starting round 3. I was happy to hear my that my beta hcg dropped to less than 1. I understand the 3 round standard protocol. But if my tumor markers are that low, is there really a need for the third round? My only conclusion is that it will kill off any remaining cancer cells. Has anyone had this experience before?

[JoeTheAstronaut]

I think they want to make sure they kill all the micromets that might not even show up on the tests... Good to hear you're doing well!!

[Mike]

If the decision is made to use BEPx3 prior to chemo starting then it should continue without regard to tumor markers dropping. The old standard was to do BEPx4 for everyone and it was reduced to BEPx3 for those with good risk disease. It is great that the beta-hCG has normalized but the next round is still needed. Remember, some guys have metastasis and no tumor markers at all, so they don't always tell the full story. All the best on round 3.

Mike

[Goodday]

Got it. I talked to my onc about next steps once I am done with chemo. He referred to the National Comprehensive Cancer Network guidelines(https://www2.tri-kobe.org/nccn/guide...testicular.pdf)

Does anyone else's onc use this as their primary guideline or do each onc go by a case by case basis? I am looking forward to the finish line and would like some semblance in how surveillance works based on you, current patients, survivors and care takers. Also, would like to see if I can push for a different schedule. As you can tell, I am a bit anxious.

Any help is much appreciated.

Thanks.

[biwi]

If you fit within the NCCN, it is definitely the best case treatment path to follow it. It has been tuned by experts over many years to achieve the best outcomes for the majority of the cases. Unless your case is very advanced or somehow extraordinary, NCCN guidelines are really the standard to follow.

[Goodday]

Thank you for your feedback. I did come across an issue this past week in terms of side effects. I started feeling my lungs feel a bit blocked when taking deep breaths. During the past two cycles, I've recovered from it but this time around, its been lingering longer. I had my chest x-ray and it they came back negative. I will also be getting antibiotics and pulmonary lung function test.

With that said, my last two bleo treatments are on hold until we figure out my lung situation. My onc said he may consider another round of EP but it's not for certain. I had two masses that measured 2.6 x 2.6 cm at the level of the renal hilus in the left para-aortic space and just inferior to this is an additional nodal mass measuring approximately 3.1 x 2.1 cm.

Per my last blood work, my bhcg dropped to less than 1. I am wondering if an extra round of EP is overkill or if even the last two bleo infusions are necessary. Any feedback is much appreciated.

[biwi]

So you have only had 1 bleo? If you only had that one bleo, and are going to stop bleo, I suspect the experts would all say switch protocols to 4xEP.

EDIT: also, I would also absolutely not drop bleo without performing the lung test. Chemo (EP) causes all sorts of sensations, and tiredness. I got quite a bit of shortness of breath and I didn't even have bleo. So I wouldn't be so quick to attribute it to the bleo.

[Violet0729]

I thought pure seminoma spread very slow. Goodday did you wait too long to get your testicle checked before knowing it was cancer? I’m just curious since my husband has pure seminoma and after a year of surveillance, now it spread to a lymph node. I guess it took a year to spread. Now I’m scared.

[Goodday]

Hi there. @biwi, we're definitely moving forward with a pulmonary lung function test before continuing with the last two bleo treatments. I suspect that it may be have been culmination of the past 7 weeks. It was a bummer to have put treatment on hold. I suspect this is nothing serious and can continue.

@violet0729 to give you some context, I had a physical done back in August with everything normal. Fast forward to Thanksgiving, that's around the time I started to feel some abnormality but I may have just ignored a week or two prior. Part of me is disappointed that I didn't get it checked out sooner.