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Am I waiting too long for adjuvant chemo?

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  • Am I waiting too long for adjuvant chemo?

    I was diagnosed with stage 1b nonseminoa with LVI. My oncologist gave all 3 options as equal (1xBEP, surveillance, RPLND) based on NCCN. I picked the 1xBEP but treatment won’t start until 2/18, which is pretty much 6 weeks after the surgery. Here is my timeline:

    1/7 - Blood work all normal
    1/9 - Orchiectomy to remove left testicle
    1/25 - CT and chest x-rays taken and are all clear
    1/28 - Oncologist presents options based on NCCN guidelines; diagnosed 1b (65% ec; 35% seminoa)
    2/5 - Pulmonary function test scheduled for lungs
    2/18 - 1xBEP chemo scheduled to start (1 day under 6 weeks from surgery)

    I am concerned that this obviously gives more opportunity for metastasis. How do they know when I start that I shouldn’t be doing 3xBEP instead of 1xBEP?

  • #2
    It is only 3 weeks from your clear CT, though, so probably nothing to be concerned about. If you had undetectable mets when you got your CT, thye won't have much time to grow. Good luck with chemo! It shouldn't be too awful, the majority get through one cycle with few problems.

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

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    • #3
      Maybe you should contact Dr.Einhorn. I remembered my son was 28th May had surgery, and 9th July I asked for BEPx1, he said then we need repeated all studies to make sure we are still in stage 1. So we choosed surveillance.

      TC cells are tricky, and easy change to chemo resistance. So better start chemo as earlier as possible if for 1 cycle. But I am not a doctor, pls consult your doctor.

      Best Regards

      Amy, Ryan’s mum
      Son Ran, 24 years old, 25th May 2018 diagnosed NSGCT. 28th May 2018 right orchiectomy. Pathology:50% EC, 30% Teratoma,20% Yolk sac. CTs: 1 retroperitoneal lymph node 0.7mm Tumor markers: AFP 497, bhcg 19, LDH normal Normalized after R/O. Stage 1, surveillance 17th September 2018, Bhcg elevated up to 5.6 AFP and LDH normal, CT stable. 4th November bhcg up to 28, AFP and LDH normal. BEPx3 started and 2nd January 2019 BEP finished with Tumor markers normalized. 13th February 2019 CT scan showed 1 retroperitoneal lymph node enlarged up to 1.1 cm with normal tumor markers. RPLND : 03/14 2019@IU Dr.Cary Pathology report: one lymph node from 57 is Teretoma .Back to surveillance 05/02/19 Blood work all normal

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      • #4
        For adjuvant therapy, like BEPx1 for stage I nonseminoma, the recommendation is usually that there is a CT scan within 4 weeks and tumor markers within 7-10 days before the start of the BEP just to confirm that indeed things are still stage I. If you had your CT on January 25th then it appears CT wise you would fall in that range. Perhaps just checking your tumor markers before starting BEPx1 would be a reasonable thing to ask the doctor about.

        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

        For some reason I do not get notices of private messages on here so please feel free to email me directly at mike@tc-cancer.com if you would like to chat privately so as to avoid any delays.

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        • #5
          Just curious - I heard that Carboplatin is often given as adjuvant chemo, was that option on the table?
          July 2016 - Left I/O
          December 2016 - BEPx3
          All clear for 2.5 years now + new baby!

          Simplify Cancer: Man's Guide to Navigating the Everyday Reality of Cancer
          My Testicular Cancer Support Kit
          First Oncologist Visit Checklist
          Simplify Cancer Podcast

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          • #6
            Thanks for all the replies. I did reach out to Einhorn and he said the wait was “no problem”. He did add that they should do tumor markers before the chemo and if they’re elevated then I should do 3xBEP. I am booked for a peripheral blood draw the morning I start chemo. I assume they will do tumor markers but I’ll confirm with my oncologist.

            If nothing else, this proves that I don’t have the willpower for surveillance.

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            • #7
              Originally posted by JoeTheAstronaut View Post
              Just curious - I heard that Carboplatin is often given as adjuvant chemo, was that option on the table?

              I was just offered BEP.

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              • #8
                Carboplatin is only used for pure seminoma.
                Jan, 1975: Right I/O, followed by RPLND
                Dec, 2009: Left I/O, followed by 3xBEP

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