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Treatment Name: BEP (Bleomycin + Etoposide + Cisplatin)­ 3-Day

BEP (Bleomycin + Etoposide + Cisplatin)­ 3-Day is a Chemotherapy Regimen for Testicular Cancer

How does BEP work?
Each of the medications in BEP is designed to slow the growth of and kill cancer cells.

B - Bleomycin
E - Etoposide
P - Platinol® (Cisplatin)

Alternative names: bep, bep chemo

Goals of therapy:
BEP is given to shrink tumors and alleviate the signs and symptoms of testicular cancer. BEP is commonly given with the goal of cure.

Schedule

  • Bleomycin intravenous (I.V.) infusion over 10 minutes on Days 1, 8, and 15
  • Etoposide I.V. infusion over 1 hour on Days 1, 2, and 3
  • Cisplatin I.V. infusion over 1 hour on Days 1 and 2 only

Typically, all three drugs are given on day 1. CIsplatin and Etoposide are then given on day 2, but only etoposide is given on day 3 of each cycle. Bleomycin is typically given on days 1, 8, and 15, but may be changed to days 2, 9, and 16 instead.

Estimated total infusion time for this treatment:

  • Up to 3 hours
  • Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time

BEP is usually given in an outpatient infusion center, allowing the person to go home afterwards. On occasion, BEP may be given in the hospital.

BEP is repeated every 21 days. This is known as one cycle. Each cycle may be repeated up to 4 times, depending upon the stage of the disease and specific type of testicular cancer. Duration of therapy may last up to 4 months, depending upon response, tolerability, and number of cycles prescribed.

Click here for common starting doses

Side Effects

In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported side effects with BEP are shown here:

It is important to note that these studies were done when many of the anti-nausea medications we have now were not available. Today, the percent of patients experiencing Nausea or Vomiting is expected to be much lower.

Side effect videos Side Effect Videos
Nausea and VomitingNausea and VomitingFatigue Fatigue Neutropenic FeverNeutropenic Fever

Monitoring

How often is monitoring needed?
Labs (blood tests) may be checked before and during therapy as well as periodically in follow-up after each cycle. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), blood magnesium levels, blood potassium levels, plus any others your doctor may order.

How often is imaging needed?
Imaging may be checked before treatment, immediately after treatment is finished, and during routine follow-up. Imaging may include: computed tomography (CT) scan, magnetic resonance imaging (MRI), bone scan, or x-ray.

Pulmonary functions tests (PFTs) are typically performed prior to starting treatment to ensure your lungs are healthy enough to receive bleomycin. These may be rechecked during treatment and after treatment is finished during routine follow-up.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue BEP as planned, or delay or switch therapy

ChemoExperts Tips

  • Intravenous (I.V.) fluids may be given while receiving cisplatin to maintain good hydration and protect against kidney damage. These fluids may contain electrolytes such as potassium and magnesium
  • Prior to the first dose of bleomycin on cycle 1 only, a small test dose of bleomycin is sometimes given to ensure that no infusion reactions occur. If the test dose is tolerated, the remainder of the full dose is infused. The test dose does not need to be repeated every cycle
  • Treatment with BEP may decrease sperm count. Prior to starting treatment, discuss with your doctor options for sperm banking, if interested
  • Typically, filgrastim (Neupogen®) is given after chemotherapy to stimulate production of white blood cells and avoid periods of neutropenia
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for testicular cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications.

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for BEP (Bleomycin + Etoposide + Cisplatin)­ 3-Day, we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for BEP (Bleomycin + Etoposide + Cisplatin)­ 3-Day. Depending upon your income, they may be able to help cover the cost of:

  • Bleomycin
  • Etoposide
  • Cisplatin

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as BEP (Bleomycin + Etoposide + Cisplatin)­ 3-Day and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with BEP (Bleomycin + Etoposide + Cisplatin)­ 3-Day

Individual Drug Label Information

Bleomycin (Blenoxane®)

  • Bleomycin is an intravenous (I.V.) infusion
  • FDA Boxed Warning for severe lung toxicity. This risk is increased in smokers, patients above the age of 40 years, history of radiation therapy to the chest, use of supplemental oxygen, and patients with high lifetime doses of bleomycin
  • May cause wheezing or shortness of breath. A test dose (1 unit) may be given on Cycle 1, Day 1 to make sure that the remaining dose if safe to give.
  • Dosage adjustments may be required for kidney function 
General Bleomycin (Blenoxane) Side Effects
  • Can cause various skin changes such as rash, or increased skin pigmentation. Skin changes, when they occur, may not develop until the second or third week of treatment
  • Mouth sores
  • Hair loss
  • Trouble breathing
  • Click on the bleomycin (Blenoxane) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Hair LossHair LossPainPain

See DailyMed package insert.

Etoposide (VP-16)

  • Etoposide is an intravenous (I.V.) infusion that is typically given over 30-60 minutes or in some instances, as a continuous infusion
  • Etoposide interacts with grapefruit juice and can cause increased exposure to etoposide if taken together
  • Dosage adjustments may be required for decreased kidney or liver function
General Etoposide (VP-16) Side Effects
  • Often causes temporary hair loss, which is usually reversible after stopping etoposide therapy
  • Gastrointestinal side effects such as diarrhea, mouth sores, nausea and upset stomach can be common
  • Although rare, it has been linked to the development of acute leukemia (2-12%) and typically occurs 2-3 years after therapy
  • May cause low blood counts (white blood cells, red blood cells, and platelets)
  • Click on the etoposide (VP-16) package insert below for reported side effects and potential drug Interactions

Side Effect Videos
DiarrheaDiarrheaHair LossHair LossFatigue Fatigue BleedingBleedingAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

Cisplatin (Platinol®)

  • Cisplatin is an intravenous (I.V.) infusion that is typically given over one to two hours
  • Cumulative toxicity to kidneys from cisplatin can be severe 
  • Other toxicities from multiple doses are:  low blood counts, nausea, vomiting, and hearing loss
  • Dosage adjustments may be required for poor kidney function or bone marrow toxicity (low blood counts) 
  • Cisplatin is hazardous to a human fetus; women should avoid pregnancy while on this drug 
  • Women should not breast-feed while on cisplatin; it has been reported to be in human milk 
  • Patients on anticonvulsant drugs may have decreased levels while on cisplatin 
General Cisplatin (Platinol) Side Effects 
  • Kidney problems (nephrotoxicity), especially in elderly patients. 
  • Nausea and vomiting, both acute (within first 24 hours) and delayed (two to five days after infusion) 
  • Diarrhea 
  • Low blood cell counts (myelotoxicity, acute leukemia)
  • Hearing problems- ringing ears.  All patients should have a baseline hearing test done.  All children should have hearing test done before each dose and for several years after therapy is complete 
  • Low blood electrolytes:  magnesium, potassium, calcium, sodium, and phosphate
  • Nerve pain 
  • Vision problems; improvement and/or complete recovery usually occurs after stopping therapy 
  • Liver toxicity; recovery usually occurs after stopping therapy 
  • Click on the cisplatin (Platinol) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaFatigue Fatigue PainPainAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

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References

1. de Wit R, Roberts JT, Wilkinson PM, et al. Equivalence of three or four cycles of bleomycin, etoposide, and cisplatin chemotherapy and of a 3- or 5- day schedule in good-prognosis germ cell cancer: a randomized study of the European Organization for Research and Treatment of Cancer Genitourinary Tract Cancer Cooperative Group and the Medical Research Council. J Clin Oncol. 2001;19:1629-1640.

Created: November 8, 2015 Updated: May 7, 2017

What is Testicular Cancer?

A disease of the germ cells found in the testicles. Testicular cancer is most commonly diagnosed in males ages 15 - 35 and is very rarely seen in elderly men.

Currently, it is not known what causes testicular cancer, whether it is inherited or environmental. The stage of testicular cancer can vary at diagnosis and throughout treatment. Stages of testicular cancer include stages I, II, and III. The effectiveness of the treatment may depend upon the stage at diagnosis. With surgery and chemotherapy, testicular cancer is often curable.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

Common Starting Doses

  • Bleomycin 30 units intravenous (I.V.) infusion over 10 minutes on days 1, 8, and 15
  • Etoposide 165 mg/m2 I.V. infusion over 1 hour on days 1, 2, and 3
  • Cisplatin 50 mg/m2 I.V. infusion over 1 hour on days 1 and 2 only

Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability

Clinical Studies

If you are interested in reading the clinical trials results, please click on references below:

1. de Wit R, Roberts JT, Wilkinson PM, et al. Equivalence of three or four cycles of bleomycin, etoposide, and cisplatin chemotherapy and of a 3- or 5- day schedule in good-prognosis germ cell cancer: a randomized study of the European Organization for Research and Treatment of Cancer Genitourinary Tract Cancer Cooperative Group and the Medical Research Council. J Clin Oncol. 2001;19:1629-1640.

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium

Tumor lysis syndrome occurs when many cancer cells die quickly and release their contents into the bloodstream. Many times the body has the ability to flush these substances out through the kidneys or metabolize them via the liver. However, sometimes the body needs medicines to help eliminate these substances and to prevent organ damage.

Tumor lysis syndrome occurs when many cancer cells die quickly and release their contents into the bloodstream. Many times the body has the ability to flush these substances out through the kidneys or metabolize them via the liver. However, sometimes the body needs medicines to help eliminate these substances and to prevent organ damage.