Day 0: What is BEP Chemotherapy?

Hi everyone, let me introduce myself! My name is Raub and I'm a testicular cancer patient about to start his third and final cycle of BEP chemotherapy. For the next 3 weeks, I will be posting a daily log to record exactly what each day has felt like (I might even compare them to my cycles 1 & 2 since they're still fresh in my head).

This blog has two main goals. First, to calm those in a similar position as mine by showing them what BEP is like and help inform them exactly what they may encounter at various points in a cycle. Second, I want to always remember this. going through BEP chemotherapy has been an enlightening experience, and I'd like this blog as my souvenir.

First, what is BEP? BEP is a chemotherapy regimen that was pioneered in the 70's and has grown to be the standard first-line treatment in most testicular cancer patients. It consists of being administered 3 chemo drugs, generally via IV.

Drug 1: 'B' stands for Bleomycin. This drug is a broad anti-tumor drug that is used in many chemo protocols. Common side effects include fever and chills for 24 hours after being administered a dose, however I've never experienced this. The one I have experienced though, is hyper-pigmentation of the skin. Basically, instead of being just brown, parts of my body became really brown (especially new cells that have formed during my time with bleo). It's associated with long-term pulmonary (lung) toxicity.

Drug 2: 'E' stands for Etoposide. This drug works by forcing DNA, which is usually coiled into chromosomes, to unwind so it cannot be replicated, eventually causing the cell to undergo apoptosis (or self-destruct). It's actually made from the extract of a plant. Common side effects include hair loss, decreased WBC, RBC, and platelet counts, nausea, and mouth sores. It is a toxic drug that needs to be flushed out of your system as soon as possible to prevent kidney and bladder damage.

Drug 3: 'P' stands for Platinum based which is exactly what Cisplatin is! Cisplatin is a super fun drug that forces bad cuts in DNA during transcription leading to the cell's inability to replicate and eventual death. It is the most important drug you will receive. Since the use of Cisplatin for TC patients began in the 70's the survival rate has skyrocketed from 10% to over 95%; be happy, very happy. However it's known to be nephrotoxic, neurotoxic, and ototoxic, meaning it can be harmful to your kidneys, nerves, and hearing. Furthermore it can cause imbalances in your magnesium, sodium, and calcium levels. Its side effects include: kidney damage, liver damage, loss of hearing (at higher frequencies), loss of sensitivity in fingertips, and a metallic taste in your mouth.

I know I'm listing a lot of side effects, but something to keep in mind is that they're not guaranteed to happen to everyone, except for fatigue and nausea. If you find a way to get through your treatment with no fatigue or nausea, you have been blessed with a miracle. I remember I was overwhelmed with fatigue in my first cycle. On days 6 and 7, I slept 36 out of 48 hours, and when I was awake all I wanted to do was lay there curled up in a ball and stare at a blank white wall, waiting for things to get better.

All in all, here's how I describe chemotherapy: Chemo is a thrill ride where you grab the handlebars and cling on for dear life as the drugs do whatever the hell they want with your system.

That about ends this message! One last thought for all you out there: Find as many different types of resources as you can. If you don't know where to start, check out my resources & blogs I like post page.

I hope this blog will prove to be helpful. My second cycle of chemo was 1000x better than my first cycle of chemo because I knew what to expect.

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Oh, in case you're wondering my pathology/tumor markers/timeline:

Official Diagnosis:

Stage 3A+Good Risk TC exhibiting 3 enlarged lymph nodes sizes 2.5 x 2.4 cm, 2.0 x 2.8 cm, and 1.6 x 1.8 cm as well as non-calcified pulmonary nodules scattered in both lungs. No signs of Liver or Brain Metastases. Histology- 100% Embryonal Carcinoma (EC)

Tumor Markers:

Pre Surgery- 4/25/2011

AFP: 17.1

HCG: 1290

Post Surgery- 5/9/2011

(A): 5.5

(H): 1842

Pre Chemo- 5/21/2011

(A): 5.8

(H): 2942

Post Cycle 1- 6/12/2011

(A): 2.9

(H): 29

During Cycle 2 (Week 5)- 6/20/2011

(A): 2.9

(H): <2

Timeline:

4/25/2011 ~ Preliminary diagnosis of TC
4/26/2011 ~ Left I/O (surgery)
5/06/2011 ~ Official Diagnosis: Stage 3A, 100% EC, 3xBEP Chemo rec.
5/23/2011 ~ Cycle 1, Day 1
5/25/2011 ~ Brain MRI came back clean
6/13/2011 ~ Cycle 2, Day 1
6/20/2011 ~ AFP 2.9, HCG <2, LDH normal! ALL 3 MARKERS NORMAL!
7/4/2011 ~ Cycle 3, Day 1
7/25/2011 ~ CT Scan: Largest Abdominal node 1.3 x1.1cm, Largest pulmonary nodule 7mm. Doc consulted Einhorn, rec. follow-up scan.

9/16 ~ AFP 2.0, HCG <5. Moved states and now under Dr. Vaughn's care at UPenn's Abramson Cancer Center.

10/24 ~ CT Scan & Chest x-ray: ALL CLEAR

10/24 and on ~ Surveillance...