Chemotherapy is the use of anti-cancer drugs to kill cancer cells throughout the body. Most anti-cancer drugs are given by injection into a vein. Chemotherapy is most often used in conjunction with surgery. The use of anti-cancer drugs following surgery is known as adjuvant therapy.
Chemotherapy is a systemic therapy, meaning that drugs travel throughout your body via your bloodstream and affect normal as well as cancerous cells. Side effects depend largely on the specific drug(s) being used, your general health, and the dose. Some common side effects include bone marrow depression (increased risk for bleeding, anemia, and infection), fatigue, nausea/vomiting, rash, and/or hair loss. If you will be having chemotherapy, you will be given complete information about the specific drugs in your regimen.
Advances in chemotherapy during the 1970s have made testicular cancer one of the most curable solid tumors, with a 5-year survival rate of over 95%.
Chemotherapy regimens for testicular cancer include EP (etoposide and cisplatin) and BEP (bleomycin, etoposide and cisplatin). The regimen and the number of cycles are determined by a number of factors, which you may discuss in more detail with your physician.
Chemotherapy is typically given in cycles of 3-4 weeks each. The cisplatin-based combination was responsible for curing patients with testicular cancers that has spread to multiple organs in the body. The results of clinical trials showed a survival rate of 77%, and so, as of 1987, it became the standard of care.
Chemotherapy Regimen: BEP
Bleomycin, etoposide, and cisplatin are given in a combination over the course of 3 weeks. During the first week, you are here for 5 days in a row for a number of hours each day.(Sometimes this therapy is given as an inpatient in the hospital) You then return once per week for the next 2 weeks for an additional infusion. All these infusions together make up 1 cycle of BEP chemotherapy.
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Chemotherapy Regimen: EP
If your physician feels that the drug bleomycin is not right for you, then he/she may choose to give the regimen without it. You would have the 6-hour infusion of etoposide and cisplatin Monday through Friday for week 1, then 2 weeks with no infusions. These 3 weeks would be 1 cycle of EP.
Other Chemotherapy Regimens
There are a number of other chemotherapy options and combinations possible. Other drugs that may be recommended by you doctor include:
Bone Marrow Transplant/High Dose Chemotherapy
Some men with advanced or recurrent testicular cancer may have a bone marrow transplant, which allows for high doses of chemotherapy.
Bone marrow makes and stores white blood cells, red blood cells, and platelets and the high doses of chemotherapy destroy the bone marrow, putting you at great risk for infection, anemia, and excessive bleeding.
So, before your high dose chemotherapy, bone marrow or peripheral stem cells are removed and frozen. After chemotherapy is over, the cells are thawed and returned to you through a needle.