Reply With QuoteNope, the BEP cycle repeats every 21 days for TC and not 28.
Registered User
My son is due to start on Tuesday, 1/24/12. We were told last week that he will have 3 - 28 day "rounds". The nurse said a 28 day round will be day 1,2,3,4,5 and then off until day 9, and back again on day 16 and then off until day 28 and start back for round 2 with the same schedule, etc. for 3 rounds. Does that sound right? Everything I am reading here seems to be 9 weeks for BEPx3. Also, is there a possibility of adding another round to make it BEPx4 if he doesnt respond well. Thank you all very much for any advice/input you may have.
Stage IIB
12/29/11 - Diagnosed AFP-181,HCG-30,LDH - 181
12/30/11 - R I/O 40% EC,40% yolk sac, 10% chorio,immature teratoma with islands of immature & atypical cartilage
12/30/11 CT - 6 nodes largest is 2.8 x 2.2 cm
1/13/12 - AFP-24, HCG -7, LDH-389
1/24/12 - BEP x3 round 1 began
3/27/12 - BEPx 3 completed,6 nodes remain largest 2.9 x 2.2
4/26/12 - RPLND at University of Colorado,1dead, 5 teratomas
5/3/12 - All clear - surveillance
7/19/12, 10/1912 - all clear!
Administrator
Nope, the BEP cycle repeats every 21 days for TC and not 28.
Steve - http://www.caringbridge.org/visit/stevep
February 2011 - DX Stage IIB, 90% Embryonal Carcinoma, 10% Yolk Sac
Mar-May 2011 - EPx4 per Dr. Bosl at MSKCC, administered locally in DC
6-Jun 2011 - post chemo CT shows one lymph node at 1.4cm remaining
22-Jun 2011 - RPLND with Dr. Sheinfeld at MSKCC, all 51 nodes removed negative
Dec 2012 - 1.5 YEARS ALL CLEAR!
Registered User
Thank you for replying so quickly. Does that regimen of days 1-5, 9 and 16 sound right? I guess I am looking for reassurance that we are getting the best care we can get for him. I have had 3 opinions so far, all 3 doctors agree, but everyone on these boards seem to have the best advice yet.
Stage IIB
12/29/11 - Diagnosed AFP-181,HCG-30,LDH - 181
12/30/11 - R I/O 40% EC,40% yolk sac, 10% chorio,immature teratoma with islands of immature & atypical cartilage
12/30/11 CT - 6 nodes largest is 2.8 x 2.2 cm
1/13/12 - AFP-24, HCG -7, LDH-389
1/24/12 - BEP x3 round 1 began
3/27/12 - BEPx 3 completed,6 nodes remain largest 2.9 x 2.2
4/26/12 - RPLND at University of Colorado,1dead, 5 teratomas
5/3/12 - All clear - surveillance
7/19/12, 10/1912 - all clear!
Moderator
Yes, those are the right days, but as Steve mentioned it is a 3-week cycle, not 4, so q21 days.
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; 1.5 years ALL CLEAR
Administrator
Just wanted to add, that this sorta makes me nervous. If somebody goes 3 round of BEP and they haven't gotten a complete response as far as markers goes, it's a sign that the cancer is resisting the BEP regimen and that a second-line chemo ought to be tried rather than another round of BEP. 4xBEP is the norm for more advanced stages, but 3xBEP ought to be plenty to lick IIB cancer pretty good. If not, you might want to ask about TIP or VeIP secondary chemo rather than another BEP round to make it 4x, as this is what's spelled out in the NCCN guidelines for TC starting from IIB.Originally Posted by JoeysMom
Steve - http://www.caringbridge.org/visit/stevep
February 2011 - DX Stage IIB, 90% Embryonal Carcinoma, 10% Yolk Sac
Mar-May 2011 - EPx4 per Dr. Bosl at MSKCC, administered locally in DC
6-Jun 2011 - post chemo CT shows one lymph node at 1.4cm remaining
22-Jun 2011 - RPLND with Dr. Sheinfeld at MSKCC, all 51 nodes removed negative
Dec 2012 - 1.5 YEARS ALL CLEAR!
Registered User
Thanks - that is very good to know. I appreciate it and will bring that up to our oncologist on Tuesday
Stage IIB
12/29/11 - Diagnosed AFP-181,HCG-30,LDH - 181
12/30/11 - R I/O 40% EC,40% yolk sac, 10% chorio,immature teratoma with islands of immature & atypical cartilage
12/30/11 CT - 6 nodes largest is 2.8 x 2.2 cm
1/13/12 - AFP-24, HCG -7, LDH-389
1/24/12 - BEP x3 round 1 began
3/27/12 - BEPx 3 completed,6 nodes remain largest 2.9 x 2.2
4/26/12 - RPLND at University of Colorado,1dead, 5 teratomas
5/3/12 - All clear - surveillance
7/19/12, 10/1912 - all clear!
Registered User
My son, whom I call DAS, just completed round 1 of BEP last Wednesday. Because of unusual circumstances, he had the first dose of all three drugs on a Wednesday, and the second and third doses of Bleo on the following two Wednesdays. Because the doctors are concerned that his tumors are teratoma, DAS has a ct scan and blood test tomorrow morning. If the tumors are responding to the BEP, he will begin the second cycle on Tuesday. So for him, it's 21 days, and then it starts over the next week.
The premeds with each treatment have been very effective, and he's had no pain or nausea until yesterday, following his first shot of Neupogen. Neupogen stimulates the bone marrow to produce new blood cells, and it can cause the bones to ache. DAS told the doctor that he didn't want a pain killer, but tonight, after suffering what he called unbelievable pain for 24 hours, he gave in and called for help.
Bravery isn't worth it. If the doctors offer pain medicine, fill the prescription and keep it in the cabinet in case it is needed. Keep us posted on your son's treatment. We're all keeping you both in our prayers for great results.
Dane after Dr. Einhorn told him his tumor was gone. (4/10/12)
2/9/10 - left oriectomy. Tumor 3.8 cm; focal lymphovascular invasion.
EC - 35%; Teratoma with immature neuroectodermal elements - 35%; Seminoma - 20%; Yolk sac - 10%;
3/16/10 - Left RPLND at IU. All clear. Surveillance for 18 mos.
12/16/11 - LDH 476; AFP 1.1; HCG 6. CT scan: tumors in lymph node and on renal artery
2/27/12 - BEP x 3
4/11/12 - Surgery cancelled at IU. Cancer (seminoma) is gone.
Moderator
Should DAS (or Joey for that matter) need Neupogen again, have him take a Claritin when he gets the shot. Works wonders for most people.
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; 1.5 years ALL CLEAR
Registered User
Joey just had day one of chemo today, which they hesitated to start on a Tuesday because it should be 5 days in a row but day 5 lands on a Saturday so we are doing the day 5 chemo regimen on Monday of next week. BUT Joey's tumor markers from last week were higher than the previous week so we opted to start today instead of waiting one more week. Hope that is okay, this entire process is so scary, I hope we are making the right decisions. I am very worried that his markers increased.
Stage IIB
12/29/11 - Diagnosed AFP-181,HCG-30,LDH - 181
12/30/11 - R I/O 40% EC,40% yolk sac, 10% chorio,immature teratoma with islands of immature & atypical cartilage
12/30/11 CT - 6 nodes largest is 2.8 x 2.2 cm
1/13/12 - AFP-24, HCG -7, LDH-389
1/24/12 - BEP x3 round 1 began
3/27/12 - BEPx 3 completed,6 nodes remain largest 2.9 x 2.2
4/26/12 - RPLND at University of Colorado,1dead, 5 teratomas
5/3/12 - All clear - surveillance
7/19/12, 10/1912 - all clear!
Registered User
My son was unable to start his BEP until a Wednesday; however, the doctor was anxious for him to get started. Since the oncologist's office was closed on the weekend, DAS went to the local hospital, which required him to be admitted and spend the night to get the final two doses on Saturday and Sunday.
Because of scheduling, he started cycle 2 today, and this time, his oncologist has a nurse going into the office to administer doses for 2 patients on Saturday.
I'm surprised that they are skipping the weekend. You might ask if there is another oncologist whose office will administer those final doses so that you can get it on 5 consecutive days. The experts on the forum may tell us that it really doesn't matter whether he skips a day or two.
Lynn
2/9/10 - left oriectomy. Tumor 3.8 cm; focal lymphovascular invasion.
EC - 35%; Teratoma with immature neuroectodermal elements - 35%; Seminoma - 20%; Yolk sac - 10%;
3/16/10 - Left RPLND at IU. All clear. Surveillance for 18 mos.
12/16/11 - LDH 476; AFP 1.1; HCG 6. CT scan: tumors in lymph node and on renal artery
2/27/12 - BEP x 3
4/11/12 - Surgery cancelled at IU. Cancer (seminoma) is gone.
Moderator
I am surprised as well, both as to why they started on a Tuesday and why they are splitting the first cycle. As far as I know no one has ever distinctly studied whether or not splitting the heavy chemo week makes a clinical difference because the schedule is so tightly adhered.
I would suggest, Annie, pushing your office to find a suitable place for a Sat infusion - cancer doesn't wait to grow just because it is a weekend, and chemo shouldn't be delayed, if possible, for the same reason.
You mentioned the markers increased - what were they at last test?
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; 1.5 years ALL CLEAR
Registered User
Hmmmm, I did try to push to find a place for a Saturday infusion but cannot find a place to have it done. They assured me that sometimes because of the holidays they miss a couple days then and that it doesn't make much of a difference. He is having day 5 now on Monday and so far he is tolerating it well. He had his bleomycin today and it went well. For his second cycle he is starting on a Monday though to get those 5 days in a row. Does anyone know of a Denver area cancer center that is open on Saturdays? We are going to Rocky Mountain Cancer Center but I do not know if I can find a place if we are working with them, I am concerned now though.
Stage IIB
12/29/11 - Diagnosed AFP-181,HCG-30,LDH - 181
12/30/11 - R I/O 40% EC,40% yolk sac, 10% chorio,immature teratoma with islands of immature & atypical cartilage
12/30/11 CT - 6 nodes largest is 2.8 x 2.2 cm
1/13/12 - AFP-24, HCG -7, LDH-389
1/24/12 - BEP x3 round 1 began
3/27/12 - BEPx 3 completed,6 nodes remain largest 2.9 x 2.2
4/26/12 - RPLND at University of Colorado,1dead, 5 teratomas
5/3/12 - All clear - surveillance
7/19/12, 10/1912 - all clear!
Registered User
almost forgot his tumor markers, his AFP is 13.6 and his HCG went from 7 to 13 and his LDH is 356
Stage IIB
12/29/11 - Diagnosed AFP-181,HCG-30,LDH - 181
12/30/11 - R I/O 40% EC,40% yolk sac, 10% chorio,immature teratoma with islands of immature & atypical cartilage
12/30/11 CT - 6 nodes largest is 2.8 x 2.2 cm
1/13/12 - AFP-24, HCG -7, LDH-389
1/24/12 - BEP x3 round 1 began
3/27/12 - BEPx 3 completed,6 nodes remain largest 2.9 x 2.2
4/26/12 - RPLND at University of Colorado,1dead, 5 teratomas
5/3/12 - All clear - surveillance
7/19/12, 10/1912 - all clear!
Administrator
Cancer doesn't consult your schedule or take a break during weekends or holidays, so your treatment shouldn't either. I would not wait until Monday to get Day 5 at all. I don't think it's going to make a difference, but I'd just assume push for them to find an out-patient infusion center to complete Day 5 on Saturday. There's GOT to be one around somewhere, they just need to set it up. A local hospital or something. There's several around me that I could go to if I needed something over a weekend. Another option is to up the dose to the European style method of delivering BEP chemo, which is done over 3 days rather than 5 in the U.S. Just double up on his last dose and give him both the Day 4 and 5 dose on Friday, and then he'll be on schedule for the next week.
Steve - http://www.caringbridge.org/visit/stevep
February 2011 - DX Stage IIB, 90% Embryonal Carcinoma, 10% Yolk Sac
Mar-May 2011 - EPx4 per Dr. Bosl at MSKCC, administered locally in DC
6-Jun 2011 - post chemo CT shows one lymph node at 1.4cm remaining
22-Jun 2011 - RPLND with Dr. Sheinfeld at MSKCC, all 51 nodes removed negative
Dec 2012 - 1.5 YEARS ALL CLEAR!
Registered User
"They assured me that sometimes because of the holidays they miss a couple days then and that it doesn't make much of a difference."
Don't let them tell you this. It is not true. They will hospitalize someone over the holidays to make sure chemo goes as scheduled. Or, infuse over 4 days instead of 5. I would question whoever told you this.
Heidi
Husband - age 51
10/20/10 - Primary mediastinal seminoma - 10 x 9.3 cm; ß-HCG = 33 (<2.6); AFP = 3.5 (<9); LDH = 274 (100-200 )
11/1/10 4X BEP
12/7/10 End Cycle 2 - ß-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
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