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Adjuvant Chemotherapy BEP: Collection of Research, Studies, Links, Probabilities...

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  • Adjuvant Chemotherapy BEP: Collection of Research, Studies, Links, Probabilities...

    Hi All,

    I am currently between treatments, adjuvant chemotherapy is likely to start soon... I did a lot of research on this topic, and just wanted to share links to some links that I have collected.

    I hope you find this interesting, but I have learned that all the statistics and probabilities don't really mean much for me. You have to live with your decision and it basically comes down to personal preference. If you are willing to accept a 30 - 50% relapse risk, then you are fine on surveillance; for someone like myself, even a 10% chance would be too much to bear. I rather kill this thing now (maybe it is already gone completely - that's the 1m£ question) than haev to have 3 or 4xBEP later on.

    I am happy to share thoughts and all the information I could gather so far, if anyone needs support.


    Oliver, Raja, Ong, Gallagher
    Pilot study to evaluate the impact of a policy of adjuvant chemotherapy for high risk stage 1 malignent teratoma on overall relapse rate of stage 1 cancer patients.
    J Urol (1992); 148:1453-5

    Conclusion: 1xBEP reduced relapse risk to <5%.

    Pont, Albrecht, et al
    Adjuvant chemotherapy for high-risk clinical stage I nonseminomatous testicular germ cell cancer: long-term results of a prospective trial.
    J Clin Oncol. (1996), Feb; 14(2)

    Conclusion: For VASC(+) patient (high-risk group), 2xBEP reduced relapse risk to 2.4%.

    Cullen, Stenning, Parkinson
    Short-course adjuvant chemotherapy in high-risk stage I nonseminomatous germ cell tumors of the testis: a Medical Research Countil report.
    J Clin Oncol (1996); 14:1106-13

    Conclusion: Relpase risk for 104 patients was reduced to 0.9% after 2xBEP.

    Chevreau, Mazerolles, et al
    Long-term efficacy of two cycles fo BEP regimen in high-risk stage I nonseminomatous testicular germ cell tumors with embryonal carcinoma and/or vascular invasion.
    Eur Urol (2004), Aug; 46(2)

    Conclusion: 40 Patients were followed up after 2xBEP. No relapses. That's how we like it!

    Boehlen, Borner, Sonntag, et al
    Long-term results following adjuvant chemotherapy in patients with clinical stage I testicular nonseminomatous malignant germ cell tumors with high risk factors.
    J Urol (1999)

    Conclusion: Again, no relapse reported for 58 patients after 2xBEP.

    Albers, Siener, Krege
    Randomized phase III trial comparing retroperitoneal lymph node dissection with one course of bleomycin and etoposide plus cisplatin chemotherapy in the
    adjuvant treatment of clinical stage I Nonseminomatous testicular germ cell tumors: AUO trial AH 01/94 by the German Testicular Cancer Study Group.

    J Clin Oncol: 26, 2622ff.

    Conclusion: After 1xBEP there were 2 out of 191 relapses (1%).

    Tandstad, et al
    Risk-adapted treatment in clinical stage I nonseminomatous germ cell testicular cancer: the SWENOTECA management program.
    J Clin Oncol (2009); May, 1;27

    Conclusion: Large study with 745 patients, 24 relapses after 1xBEP (3.2%).

    Westermann, Schefer, Thalman
    Long-term followup results of 1 cycle of adjuvant bleomycin, etoposide and cisplatin chemotherapy for high risk clinical stage I nonseminomatous germ cell tumors of the testis.
    J Urol (2008, 179), 163ff.

    Conclusion: 1 out of 40 patients (2.5%) relapsed after 1xBEP.

    Gilbert, Norman, Nicholl
    BJU Int (2006, 98), 67ff.

    Conclusion: 0 out of 22 patients relapsed after 1xBEP.

    Amato, Ro, Ayala, Swanson
    Urology (2004), Jan; 63(1)

    Conclusion: After traditional 2xBEP protocol, 0 out of 76 patients relapsed.

    Kollmannsberger, Moore, Murray, et al
    Non-risk-adapted surveillance for patients with stage I nonseminomatous testicular germ-cell tumors: diminishing treatment-related morbidity while maintaining efficacy.
    Ann Oncol (2010), Jun; 21(6)

    Conclusion: 30 out of 58 patients with VASC(+) relapsed on surveillance. Survival was 100%.

    Maroto, Garcia del Muro, et al
    Multicentre risk-adapted management for stage I non-seminomatous germ cell tumors
    Ann Oncol (2005), Dec; 16(12)

    Conclusion: 2xBEP, and 2 out of 231 patients relapsed (<1%).

    Divrik, Akdogan, Ozen
    Outcomes of surveillance protocol of clinical stage I nonseminomatous germ cell tumors - is shift to risk adapted policy justified?
    J Urol: 2006 Oct; 176

    Conclusion: 31.3% (66 out of 211 patients) relapsed on surveillance. For VASC(+) patients the relapse rate was as high as 75%, while >50% EC relapse rate was 40.9%.

    Sturgeon, Moore, et al
    Non-Risk-Adapted Surveillance in Clinical Stage I Nonseminomatous Germ Cell Tumors: The Princess Margaret Hospital's Experience
    Eur Urol 59 (2011) 536ff.;s+Experience

    Conclusion: Relapse rate was 28% (104 out of 372) patients for surveillance patients.

    Management of Stage I Testis Cancer
    Eur Urol 51 (2007) 34-44

    Surveillance or adjuvant treatments in stage 1 testis germ-cell tumors

    Vergouwe, et al
    Predictors of Occult Metastasis in Clinical Stage I Nonseminoma: A Systematic Review
    Jul 5 2013:
    • Ultrasound Suspicious
    • AFP = 33, bHCG = 66
    • --> Diagnosed with testicular tumor (left)
    • --> Same Day I/O

    Jul 8 2013: CT (Abdomen/Thoras/Pelvis) ALL CLEAR
    Jul 12 2013:
    • AFP 11, bHCG 4
    • Histology: 100% yolk sac tumor (confined to testis only) with vascular invasion

    Jul 19 2013: AFP 5, bHCG <2
    Jul 26 2013: AFP 0, bHCG <2
    Aug 5-26 2013: 1xBEP
    Monthly markers = 0, CXR (Nov 2013) CLEAR

  • #2

    Most recent Scandinavian stuff.
    Reassuring as BEP x 3 starts tomorrow for PA recurrence detected at 1 year follow up.


    • #3
      Wow! Thank you for sharing your studies sir! Im stage 1 no lvi strongly leaning toward 1 or 2 BEP.
      November 5th noticed huge/heavy Right Testicle.
      AFP 159
      November 8th 2013 - Right I\O
      November 13th CT Pelvis AB and Chest negative
      AFP 56 NO lymphatic/vascular invasion.
      Stage 1a
      High Risk 50% Embryonal Carcinoma, 40% Teratoma, 10% yok sak.
      Nov 21st AFP 28- Thinking 1 cycle adjuvant BEP
      Currently Torn between surveillance and 1 cycle of BEP!
      Much thanks to everyone in this forum!


      • #4
        I had a single cycle of adjuvant BEP last year (in the 111 trial) despite what has happened and the complications,I'd still do it again as it's better than tossing a coin waiting for your recurrence on surveillance only.
        Are you in the UK?
        If so,pm me as I am and and can then chat.


        • #5
          1 cycle BEP experience

          I had 1 cycle of BEP from 5 Aug to 26 Aug this year. I could not live with the 30 - 40% chance of relapse in my case even though the oncologist said we could go with surveillance if I wanted. The latest Scandinavian study results posted above are very reassuring indeed that 1 cycle adjuvant BEP is a good option. Of course, this is a very personal decision and there is no right or wrong, just depends on your preference. For me, the additional absolute risk reduction of 2 - 2.5% (from say 3.5% to 1%) with 2 cycles is tiny, and does not compensate sufficiently for the increased level of toxicity (if 2 cycles would provide 100% guarantee it would be a no brainer of course). Also, should there be a relapse (which we all hope we never experience!), then an additional 3 cycles seems heavy with 2 prior ones, that would be a cumulative cisplatin dose of 5 rounds, also the Bleomycin would most likely have to be substituted with Ifosfamide, 5 rounds of Bleo I don't think your lungs would withstand that...

          With regards to chemo, I have to say I expected it to be worse. However, also these experiences are very personal and can vary immensely from human to human... I did not have to throw up once (I only needed Aprepitant which is standard, and lots of Motilium, no Zofran), but of course there is a feeling of sickness, you just don't want to eat or drink, and if only very selective foods and fluids, I am sure this very individual. For some reason I could only eat a particular frozen Pizza for a week, but so what... chemo is not a time for healthy diet. The fatigue and tiredness is heavy, I was surprised how it knocks you out. However, also that was kind of OK because I just slept for 15 or 18 hours a day and the sooner it was over. The one thing quite disturbing was a weird hearing for up to 10 days after the chemo ended. I could hear, but it felt like I was under water at times and certain sounds (like flushing the toilet or showering) were completely different and strange. That's the cisplatin effect and wears off. Today: I feel great! Of course, psychologically the tumor stays with you for years to come, but physically I am fine. I went back to work 3.5 weeks after finishing chemo.

          Good luck with your decision, if you need any kind of advice or support, could be anything than just send me a message.
          All the Best for now!
          Jul 5 2013:
          • Ultrasound Suspicious
          • AFP = 33, bHCG = 66
          • --> Diagnosed with testicular tumor (left)
          • --> Same Day I/O

          Jul 8 2013: CT (Abdomen/Thoras/Pelvis) ALL CLEAR
          Jul 12 2013:
          • AFP 11, bHCG 4
          • Histology: 100% yolk sac tumor (confined to testis only) with vascular invasion

          Jul 19 2013: AFP 5, bHCG <2
          Jul 26 2013: AFP 0, bHCG <2
          Aug 5-26 2013: 1xBEP
          Monthly markers = 0, CXR (Nov 2013) CLEAR