100% EC - 3xBEP vs 4xEP

[thetaguru]

Hello everyone. This is my first post but I was curious what chemo option other people in a similar situation used and how it turned out. To give a little background, I was diagnosed on 6/28 and had a left orchiectomy on 7/3. My blood markers were all normal but I have two enlarged abdominal lymph nodes on the left side (1.5 - 1.8 cm) as well as a small spot on my right lung (4.5mm). The pathology confirms that it is 100% EC with vascular invasion. I am 30 years old and was a smoker for ten years but quit two years ago.

I met with Dr. Einhorn (superstar) at Indiana University in Indianapolis and he diagnosed me at Stage III because he thinks that there is a strong probability that the lung spot is due to TC but can not be sure since it is so small. He recommended 3xBEP due to the multiple spots and doesn't think it would require surgery. He assessed me as a good risk and a high cure probability.

I met Dr. Eggener (urologist) and Dr. Stadler (oncologist) at the University of Chicago and they diagnosed me at Stage 2A, thinking that the spot on my lung is not related. Their recommendation was 4xEP because that is the practice they follow. They also assessed me as a good risk with a high cure probability.

I am slated to start chemo on 7/30 because my wife is 22 weeks pregnant with our first and I am trying to beat this before the baby is due on Thanksgiving. I am trying to decide which route I should go. My understanding is that the difference is that the 'B' seems to give a higher cure rate but has a risk of causing permanent lung damage. What has everyone's experience been going with either treatment method? By some chance, has anyone in the Chicago area gone to either Northwestern or the University of Chicago for treatment? I appreciate any and all feedback and thank you in advance.

~Tom

[nciungan]

Different treatment centers have their preferences and I know there have been tons of studies that compare the two. The risk for problems with the Bleo are small but real. I did BEP personally but you'll find a mix of both experiences on this forum and most of us have come out on the other end somewhat bruised but OK. I think being a smoker they might lean towards EP, but I could be wrong.

[ynwa96]

Tom.

You have had the response of the world leader in this field, Einhorn. I would go with is recommendation.

I was diagnosed stage IIIb in dec 2012 with a 2.2 cm mass on my lungs. 3 rounds of BEP was my chemo schedule and I didn't have too much of an issue with the Bleo and I am a soccer coach. The mass on my lungs did not change size and I did have it removed by Video Assisted Thoracic Surgury and it wasn't cancerous.

Good luck.
Cheers
YNWA96

[Davepet]

I would always go with Dr Einhorn's recommendation. He wrote the book on BEP.

I didn't have any permanent lung problems (& most do not) I smoked for 30 years before quitting (I had quit 7 years before my 2nd TC).

Dave

[Paul54]

Sorry to have to welcome you and that you need chemo. That sucks. From all my reading, 3xBEP and 4xEP are equally effective, and if there is any statistical difference betwen the cure rates, I've never seen it. The recommendation for EP or BEP is primarily based on the experience of the various cancer centers. Prior lung problems and smoking may lean them toward EP. But the suspicious lung nodes would push toward using the Bleo since it has an affinity for lung tissue. (I believe it is used to treat lung cancer.)

This will be over before you know it. I hope they find the right combination of anti-nausea drugs. Don't be afraid to use them. Don't be a hero. Follow the advice about avoiding large crowds and people who are ill. Are you getting straight IV or a PICC line or port? From what I've read, a port seems to be the best choice.

And congrats on the baby! I bet you will back to full strength by the big day. Posting baby pictures here is mandatory.

Paul

[Nut of Mordor]

But the suspicious lung nodes would push toward using the Bleo since it has an affinity for lung tissue. (I believe it is used to treat lung cancer.)

I COULD BE WRONG on this, but I think that if lungs are badly involved by cancer (not this case by the way) it's better to avoid bleo because it can give more issues. I remember a dude that because had too much lung lesions skipped to VIP instead of BEP (can't remember who... TC Destroyer ?).
Again, don't quote me on that, but I think that if bleo hits the lungs doesn't mean it is more effective on lung metastasis.

[thetaguru]

Thank you everyone for your responses, not only on this thread but on this board as well. It is amazing how many times this board has popped up in my searches. It has provided more information than any other source and without it, I wouldn't have even known about Dr. Einhorn.

Right now I am heavily leaning towards listening to Einhorn and going with the BEP. My previous smoking did not seem to be a concern to him and when I asked the doctors in UIC regarding the bleomycin, I found out that they actually went to NY Medical school and follow the 4xEP only because it is their practice and not because of my individual case.

I guess it all comes down to juggling the side effects and personally would rather have a little more risk due to B and less risks from the extra EP.

[Fed]

In terms of effectiveness, 3xBEP and 4xEP are equivalent. The real trade-off will be on the long term effects. 3xBEP carries, as other mentioned, the possiblity of pulmonary toxicity. Many centers will give you a test dose to verify your reaction to the drug, and regular pulmonary function tests are the norm during treatment. 4xEP avoids these issues, but the extra cycle of cisplatin increases the risk of peripheral neuropathy and hearing loss.

[TC Destroyer]

I COULD BE WRONG on this, but I think that if lungs are badly involved by cancer (not this case by the way) it's better to avoid bleo because it can give more issues. I remember a dude that because had too much lung lesions skipped to VIP instead of BEP (can't remember who... TC Destroyer ?).
Again, don't quote me on that, but I think that if bleo hits the lungs doesn't mean it is more effective on lung metastasis.

You are correct sir! This is because I had extensive lung involvement and Dr. E knew I would come close to passing the pulmonary readiness test. VIP has risks as well including high blood toxicity, requiring it to be given as inpatient.

[TC Destroyer]

I am trying to decide which route I should go. My understanding is that the difference is that the 'B' seems to give a higher cure rate but has a risk of causing permanent lung damage.

~Tom

There are risks of long term lung damage, but most people come out of chemo with minimal lung damage. Think about all of the TC survivors that start completing the Livestrong Challenge annually after their battle with TC. Many of them were not athletic at all before diagnosis and many of them had BEP. I would say they probably have better lungs than they did before chemo mainly because of the fact they exercise regularly.

In addition, there is a device called an 'incentive respirator' that can help regain lung capacity and improve lung performance. I was on one of these things during and after my first two rounds of chemo, it helped tremendously.

[hismom]

you will beat this with either choice ..

Both options have their risk factors - however both BEPx3 and EPx4 are very effective in curing EC. My son has been 2 and 1/2 years all clear after completing EPx4. He was treated at Sloan-Kettering by Dr. Feldman and that is their treatment of choice. He was Stage IIIb. So take comfort in the many cases you'll find here in the forum who have had great results with either treatment.