BEP = bleomycin, etoposide, cisplatin.
- 21 day cycles
- 3 cycles for good-risk disease, 4 cycles for intermediate or poor risk disease
10 – 20 % risk neutropenia – often given with filgastrim / g-CSF.
Bleomycin
- Anti-tumour antibiotic which forms free radicals and binds and breaks DNA strains
- Pulmonary complications
- Acute pneumonitis and ARDS
- Chronic pneumonitis
- Chronic pulmonary fibrosis and oxygen hypersensitivity
- Higher risk of pulmonary toxicity in those > 40
- Skin and nail changes
- Raynaud’s
Etoposide
- Topoisomerase inhibitor causing DNA degradation and cell cycle arrest
- Causes myelosuppression and mucositis
- Dose dependent risk of leukaemia in long term
Cisplatin
- Platinum based agent which causes cross-linking of DNA
- Nephrotoxic
- Tinnitus / ototoxicity
- Peripheral neuropathy (and balance issues)
- Impaired cardiac function in long term
Carboplatin
1 x dose in adjuvant treatment stage 1 seminoma.
- Alkylating agent which cross-links DNA
- Less nephrotoxic than cisplatin
- Myelosuppression +
Other options
VIP – etoposide, ifosfamide (with Mesna), cisplatin
VeIP – vinblastine, ifosfamide (with Mesna), cisplatin (preferred for relapse after chemo)
EP – etoposide, cisplatin
Generic chemo side effects:
- Fatigue
- Nausea and vomiting
- Alopecia
- Skin and nail changes
Cardiovascular and VTE risk
- 6 x risk of MI and CVA cf. age-matched males without GCT
- 24 x risk of VTE
- Consider prophylaxis in high risk men (no strong evidence)
- Central venous access devices likely increase risk