Chemo Decision

I have delayed posting the results of our meeting with Dr. Wood on Tuesday as we attempted to make a decision. The doctor gave us 2 treatment options and we are talking to people we know & researching the two so we can make the best decision for Dan.

The two protocols (EP and BEP) are essentially identical in terms of initial cure rate. They are different in terms of length and possible side effects and potential long term survival rates. BEP has been studied for 30years so long term survival rates and long term studies are easier to find.
BEP Protocol: Bleomycin, etoposide, platinum agent (cisplatin) Bleomycin would be given every Monday for 9 weeks. Etoposide & Cisplatin would be given Monday-Friday every 3 weeks. So total treatment is 9 weeks long or 3 cycles. The BEP protocol uses less Cisplatin and Etoposide, but uses Bleomycin.

EP Protocol: Etoposide & Cisplatin. They would be given Monday-Friday every 3 weeks for 12 weeks, 4 total cycles.

Major Risks of each drug (Occured in less than 30% of patients):
Bleomycin can cause lung fibrosis in older patients (over fifty) and can be a problem in patients with extensive lung metastases or existing lung problems. Etoposide can cause leukemia many years down the road and Cisplatin can cause peripheral neuropathy (numbness and tingling in your arms/legs) and High frequency hearing loss, infertility.

Minor and Expected risks of each drug:
Fever, Chills, Hair Loss, redness or darkening of the skin, Nausea & Vomiting, low magnesium, low calcium, low potassium, low white blood cells, low red blood cells, low platelet count

Making the decision, thanks to my brother-in-law Jeff for doing some research:

Studies in the early 90s at MSKCC (Memorial Sloan Kettering Cancer Center) did use just cisplatin and etoposide for 4 cycles with similar success to PEB X 3 (cisplatin, etoposide, bleomycin-3 cycles) but today they use 3 drugs but with a lower bleomycin concentration than the Indiana University group. Furthermore, one study in 2001 showed that the Indiana protocol was superior to the MSKCC protocol. Although both showed a similar instance of complete response (90 v. 91%), the long term survival for the Indiana dosing protocol was superior (99 versus 88%). Also, a study published this last May compared BEP to EP (cisplatin and etoposide). Both produced similar response rates between the two protocols, but they were looking just at nonseminomatous germ-cell tumors. Also, the study did not have the statistical power to distinguish long term survival between the groups. Nonetheless, even the authors of that clinical trial favored the three drug combination over the two drug combination.

Friday afternoon Dan meets with the pulmonologist to have Pulmonary Function tests done and to have him review his CT-Scan of the chest and X-ray. The only thing holding us back from selecting the BEP Protocol was his "emphysema like changes to his lungs" reported by the Radiologist. These were attributed to Dan's tall and slender build but we want to make sure before we start Belomycin that his lungs are in good condition.

So a decision will be made Friday after he meets with the pulmonologist and Dr. Wood. Regardless of the protocol Dan chooses he will start Chemotherapy on Monday January 28th at 08:00.