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Hi All,
I thought it might be a good idea to post an accurate rubric of treatment protocol that outlines what is standard throughout the different stages of therapy. Although it is no substitute for what a doctor can provide in terms of personal care, it is, I think a list from which the patient can begin to be his own advocate and look over it if need be.
Scott, maybe you'll consider putting some kind of a lock on it, so that it will remain on the board for anyone who needs to refer to it.
Thanks,
Michael
Protocols For Testicular Cancer:
*** First-line therapy
US BEP (3 or 4 cycles): 21 day cycles
100 mg/m^2 etoposide (VP-16) days 1-5
20 mg/m^2 cisplatin days 1-5
30 IU bleomycin days 1, 8, 15 (or days 2, 9, 16)
Note: Some European oncologists will compress the 5-day
regimen into 3 days (165 mg/m^2 etoposide days 1, 3, 5
and 50 mg/m^2 cisplatin days 1, 3, sometimes with days
1,3,5 replaced with days 1,2,3) and some Asian oncologists
will compress the cisplatin into a single day. While this does
not affect effectiveness, the increased dosage intensity has
been shown to increase toxicity.
Note: Some oncologists will reduce the etoposide dose 20%
if the patient has previously received radiation therapy.
US EP (4 cycles): 21 day cycles
100 mg/m^2 etoposide days 1-5
20 mg/m^2 cisplatin days 1-5
Sloan Kettering prefers 4EP over 3BEP. Indiana University prefers 3BEP
over 4EP.
UK/Europe BEP:
Same as US BEP, but with 120 mg/m^2 etoposide days 1,3,5
(i.e., less total etoposide).
Sometimes will refer to BEP as PEB chemotherapy and EP as PE.
> > Radiation Therapy:
> > Stage I: 2500 rads (25 Gy) spread over 15-20 days (US) or
> > 2000 rads (20 Gy) spread over 10 days (UK)
> > may include pelvic nodes (dog leg, hockey-stick)
> > or omit pelvic nodes (para-aortic)
> > Stage II: add 1000 rads to the enlarged nodes
> >
> >
> > *** Salvage therapy
> >
> > High dose chemo with stem cell transplant:
> > 700 mg/m^2 carboplatin days 1-3
> > 750 mg/m^2 etoposide days 1-3
> >
> > VeIP: 21 day cycles
> > 0.11 mg/kg vinblastine days 1-2
> > 1200 mg/m^2 ifosfamide days 1-5
> > 20 mg/m^2 cisplatin days 1-5
> >
> > VIP/PEI: 21 day cycles
> > 20 mg/m^2 cisplatin days 1-5
> > 75-100 mg/m^2 etoposide days 1-5
> > 1200 mg/m^2 ifosfamide day s 1-5
> >
> > TIP:
> > 250 mg/m^2 paclitaxel (Taxol) day 1
> > 1500 mg/m^2 ifosfamide days 2-5
> > 25 mg/m^2 cisplatin days 2-5
> >
> > Single agent Gemzar: 28 day cycles
> > 1000-1200 mg/m^2 gemcitabine (Gemzar) days 1, 8, 15
> >
> > Note: Combination therapy such as Taxol/Gemzar or GemOx
> > has been found to be more effective.
> >
> > Taxol/Gemzar (6 cycles): 28 day cycles
> > 100-110 mg/m^2 paclitaxel (Taxol) days 1, 8, 15
> > 1000 mg/m^2 gemcitabine (Gemzar) days 1, 8, 15
> >
> > Taxol/Gemzar/Cisplatin (4 cycles): 21 day cycles
> > 80 mg/m^2 paclitaxel (Taxol) days 1, 8
> > 50 mg/m^2 cisplatin days 1, 8
> > ; 800 mg/m^2 gemcitabine days 1, 8
> >
> > GemOx (6 cycles): 21 day cycles
> > 1000-1250 mg/m^2 gemcitabine (Gemzar) days 1,8
> > 130 mg/m^2 oxaliplatin day 1
> >
> > Note: Repeats cycle so long as neutrophil count > 1500
> > and platelet count > 75000. Allows up to a 10 day delay
> > between cycles. May omit or reduce the dosage on day 8
> > (25% reduction if neutrophils 1000 to 1500 or platelets
> > 50000 to 75000, omitted if neutrophils < 1000 or platelets
> > < 50000).
> >
> > Notes:
> >
> > Ifosfamide is usually accompanied by mesna protection,
> > such as 400-500 mg/m^2 mesna before and 4h and 8h after
> > each dose of ifosfamide and/or 400 mg/m^2 mesna every
> > 8h x 5 days
> >
> > *** Experimental protocols
> >
> > Single dose carboplatin (as an alternative to prophylatic radiation
> > therapy
> > for stage I seminoma) is still undergoing clinical trials. It has been
> > proven ineffective for stage II disease.
> >
> > *** Protocols no longer in widespread active use
> >
> > PVB (4 cycles): 21 day cycles
> > 20 mg/m^2 cisplatin days 1-5
> > 0.15 mg/kg vinblastine days 1-2
> > 30 IU bleomycin days 1, 8, 15 (or days 2, 9, 16)
> >
> > Note: Found to be less effective and more toxic than BEP chemotherapy,
> > and so no longer used.
> >
> > POMB/ACE:
> > 1 mg/m ^2 (max 2 mg) vincristine day 1
> > 300 mg/m^2 methotrexate day 1
> > 15 mg bleomycin day 2
> > 15 mg folinic acid 24, 36, 48 and 60 hours after
> > methotrexate
> > 120 mg/m^2 cisplatin day 3
> > 100 mg/m^2 etoposide days 1-3
> > 0.5 mg Actinomycin D days 1-3
> > 500 mg/m^2 cyclophosphamide day 3
> >< BR>> >
I thought it might be a good idea to post an accurate rubric of treatment protocol that outlines what is standard throughout the different stages of therapy. Although it is no substitute for what a doctor can provide in terms of personal care, it is, I think a list from which the patient can begin to be his own advocate and look over it if need be.
Scott, maybe you'll consider putting some kind of a lock on it, so that it will remain on the board for anyone who needs to refer to it.
Thanks,
Michael
Protocols For Testicular Cancer:
*** First-line therapy
US BEP (3 or 4 cycles): 21 day cycles
100 mg/m^2 etoposide (VP-16) days 1-5
20 mg/m^2 cisplatin days 1-5
30 IU bleomycin days 1, 8, 15 (or days 2, 9, 16)
Note: Some European oncologists will compress the 5-day
regimen into 3 days (165 mg/m^2 etoposide days 1, 3, 5
and 50 mg/m^2 cisplatin days 1, 3, sometimes with days
1,3,5 replaced with days 1,2,3) and some Asian oncologists
will compress the cisplatin into a single day. While this does
not affect effectiveness, the increased dosage intensity has
been shown to increase toxicity.
Note: Some oncologists will reduce the etoposide dose 20%
if the patient has previously received radiation therapy.
US EP (4 cycles): 21 day cycles
100 mg/m^2 etoposide days 1-5
20 mg/m^2 cisplatin days 1-5
Sloan Kettering prefers 4EP over 3BEP. Indiana University prefers 3BEP
over 4EP.
UK/Europe BEP:
Same as US BEP, but with 120 mg/m^2 etoposide days 1,3,5
(i.e., less total etoposide).
Sometimes will refer to BEP as PEB chemotherapy and EP as PE.
> > Radiation Therapy:
> > Stage I: 2500 rads (25 Gy) spread over 15-20 days (US) or
> > 2000 rads (20 Gy) spread over 10 days (UK)
> > may include pelvic nodes (dog leg, hockey-stick)
> > or omit pelvic nodes (para-aortic)
> > Stage II: add 1000 rads to the enlarged nodes
> >
> >
> > *** Salvage therapy
> >
> > High dose chemo with stem cell transplant:
> > 700 mg/m^2 carboplatin days 1-3
> > 750 mg/m^2 etoposide days 1-3
> >
> > VeIP: 21 day cycles
> > 0.11 mg/kg vinblastine days 1-2
> > 1200 mg/m^2 ifosfamide days 1-5
> > 20 mg/m^2 cisplatin days 1-5
> >
> > VIP/PEI: 21 day cycles
> > 20 mg/m^2 cisplatin days 1-5
> > 75-100 mg/m^2 etoposide days 1-5
> > 1200 mg/m^2 ifosfamide day s 1-5
> >
> > TIP:
> > 250 mg/m^2 paclitaxel (Taxol) day 1
> > 1500 mg/m^2 ifosfamide days 2-5
> > 25 mg/m^2 cisplatin days 2-5
> >
> > Single agent Gemzar: 28 day cycles
> > 1000-1200 mg/m^2 gemcitabine (Gemzar) days 1, 8, 15
> >
> > Note: Combination therapy such as Taxol/Gemzar or GemOx
> > has been found to be more effective.
> >
> > Taxol/Gemzar (6 cycles): 28 day cycles
> > 100-110 mg/m^2 paclitaxel (Taxol) days 1, 8, 15
> > 1000 mg/m^2 gemcitabine (Gemzar) days 1, 8, 15
> >
> > Taxol/Gemzar/Cisplatin (4 cycles): 21 day cycles
> > 80 mg/m^2 paclitaxel (Taxol) days 1, 8
> > 50 mg/m^2 cisplatin days 1, 8
> > ; 800 mg/m^2 gemcitabine days 1, 8
> >
> > GemOx (6 cycles): 21 day cycles
> > 1000-1250 mg/m^2 gemcitabine (Gemzar) days 1,8
> > 130 mg/m^2 oxaliplatin day 1
> >
> > Note: Repeats cycle so long as neutrophil count > 1500
> > and platelet count > 75000. Allows up to a 10 day delay
> > between cycles. May omit or reduce the dosage on day 8
> > (25% reduction if neutrophils 1000 to 1500 or platelets
> > 50000 to 75000, omitted if neutrophils < 1000 or platelets
> > < 50000).
> >
> > Notes:
> >
> > Ifosfamide is usually accompanied by mesna protection,
> > such as 400-500 mg/m^2 mesna before and 4h and 8h after
> > each dose of ifosfamide and/or 400 mg/m^2 mesna every
> > 8h x 5 days
> >
> > *** Experimental protocols
> >
> > Single dose carboplatin (as an alternative to prophylatic radiation
> > therapy
> > for stage I seminoma) is still undergoing clinical trials. It has been
> > proven ineffective for stage II disease.
> >
> > *** Protocols no longer in widespread active use
> >
> > PVB (4 cycles): 21 day cycles
> > 20 mg/m^2 cisplatin days 1-5
> > 0.15 mg/kg vinblastine days 1-2
> > 30 IU bleomycin days 1, 8, 15 (or days 2, 9, 16)
> >
> > Note: Found to be less effective and more toxic than BEP chemotherapy,
> > and so no longer used.
> >
> > POMB/ACE:
> > 1 mg/m ^2 (max 2 mg) vincristine day 1
> > 300 mg/m^2 methotrexate day 1
> > 15 mg bleomycin day 2
> > 15 mg folinic acid 24, 36, 48 and 60 hours after
> > methotrexate
> > 120 mg/m^2 cisplatin day 3
> > 100 mg/m^2 etoposide days 1-3
> > 0.5 mg Actinomycin D days 1-3
> > 500 mg/m^2 cyclophosphamide day 3
> >< BR>> >