Home

BEP REGIMEN

Cisplatin 20 mg/m2 IV DAYS 1-5
Etoposide 100 mg/m2 IV DAYS 1-5
Bleomycin 30 units IV DAYS 2, 9, 16

REPEAT q21 days Total number of cycles varies.
Reduce etoposide by 20% with history of rediotherapy or fever with neutropenia after an earlier course.

CAUTION:
Cisplatin -- vigorous hydration is required; can be nephrotoxic and ototoxic; can cause peripheral neuropathy; hold or reduce for creatinine > 1.5

BLEOMYCIN: Give test dose of 1 - 2 units because of possible acute pulmonary, anaphylactoid, or severe febrile reactions; Dose-adjust for renal insufficiency; Total lifetime dose should not exceed 400 units; Avoid high FiO2

REF-JCO 16:1287, 1998
___________________________________________

VeIP
VINBLASTINE 0.11 mg / kg IV DAYS 1,2
IFOSFAMIDE 1200 mg / M2 / d CIV (120 hr) DAYS 1 - 5
CISPLATIN 20 mg / M2 IV DAYS 1 - 5
MESNA 400 mg / M2 IV DAY 1 - give bolus 15 minutes prior to Ifosfamide
Mesna 1200 mg / M2 / d CIV (120 hr) DAYS 1 - 5 start immediately after Mesna bolus

REF: Loehrer et al. Ann Intern Med 109:540, 1988
___________________________________________

EP

VP - 16 100 mg / M2 IV days 1 - 5
Cisplatin 20 mg / M2 IV days 1 - 5


REF-JCO 13:2700, 1995
___________________________________________

PVB
Cisplatin 20.00 mg / M2 IV days 1 - 5
VINBLASTINE 0.15 mg / kg IV days 1, 2
- reduce dose by 20% for prior radiotherapy
BLEOMYCIN 30 units IV days 2,9,16


REF:
NEJM 316:1436, 1987
Einhorn et al. Ann Intern Med 1977; 87:293 - 298
___________________________________________

VIP

CISPLATIN 20 mg/m2 IV
ETOPOSIDE 75 mg/m2 IV
IFOSFAMIDE 1,200 mg/m2 daily X 5 days

REF-JCO 16:1287, 1998
_____________________________________________________
VERY REFRACTORY PATIENTS/INTENSELY TREATED IN THE PAST

GEMCITABINE 1,000 mg/m2 IV infusion over 30 minutes once weekly for 3 consecutive weeks (days 1, 8, & 15), followed by a 1-week rest period.
Dose reduction 50% in the case of any grade 3 nonhematologic toxicity; Cessation of therapy in the case of grade 4 nonhematologic toxicity. For hematologic toxicity, 50% dose reduction in the case of thrombocytopenia (50,000 to 74,000/µL) or neutrophil counts between 500 & 1,000/µL.
REF: JCO 17(2): 512, 1999. RR=20%

Information on Bleomycin

Information on Etoposide

<><><><><><><><><><><><><><><><><><><><><><><><><><>

TESTICULAR CANCER TREATMENT OPTIONS

--->NON-SEMINOMAS

------> CLINICAL STAGE A
ORCHIECTOMY
The overall relapse rate for these patients is approximately 30% (mostly retroperitoneum)
Several studies have shown that survival rate is similar to that of pathologic stage A.
Who may be at a higher risk of recurrence? Several histopathologic features of the primary tumor have been identified that are independently predictive of relapse in multivariate analysis. These include vascular invasion; lymphatic invasion; pathologic T stage higher than 1; the presence of components of embryonal carcinoma; percent of the primary tumor occupied by teratoma; & the presence or absence of yolk sac elements.
No chemotherapy!

------> PATHOLOGIC STAGE A
ORCHIECTOMY + RPLD
The overall relapse rate for these patients is approximately l0% (mostly lung)
5-year survival rates ~98%
The current recommendation for patients with pathologic stage A nonseminomatous disease is for no further therapy to be administered following RPLND. This recommendation is based on the high surgical cure rate with orchiectomy & RPLND alone (90%), the favorable relapse pattern in patients who recur (lung only), and the effectiveness of chemotherapy for small-volume metastatic disease in relapsing patients.
No chemotherapy!

------> PATHOLOGIC STAGE B
ADJUVANT CHEMOTHERAPY (BEP X 2)
Greater than 95% cure rate?

------> CLINICAL STAGE B2
If found to have nonbulky abdominal disease (nonpalpable, mass <5 cm on CT scan, or fewer than 5 nodes involved on CT scan), traditional therapy has included RPLND with complete resection, followed by either observation until relapse or adjuvant chemotherapy with excellent results.

------> CLINICAL STAGE B3
Not surgical candidate: palpable abdominal mass, lymph nodes > 5 cm, > 5 nodes involved on CT)
These patients must be treated with primary chemotherapy. After achievement of serological remission, complete restaging should be done & if any residual mass present, surgical removal is indicated.

AFP
Produced by: Fetal Yolk Sac; Embryonic carcinoma elements of germ cell tumors.
Overall, AFP is NOT elevated in pure seminomas.
Half-life: 5 days


B-HCG
Produced by: Trophoblastic tissues; Syncytiotrophoblastic components of of germ cell tumors.
Overall, B-HCG is NOT elevated in seminomas. However, about 10% of cases may have low-level elevation of B-HCG.
Half-life: 18-24 hours
There is some cross-reactivity in the radioimmunoassay with luteinizing hormone. Also, hCG can be falsely elevated in patients who use marijuana.