The combination of cisplatin, etoposide and bleomycin (PEB) is considered to be the standard therapy in adjuvant situations for non-seminomas with vascular invasion (1-2 cycles) and for metastatic seminomas as well as non-seminomas (3-4 cycles).
In the case of contraindications to bleomycin - above all restrictive pulmonary diseases have to be mentioned - 4×PE can be used in place of 3×PEB. If the patient needs 4 cycles bleomycin can be replaced by ifosfamide. Essential examinations before starting therapy are general laboratory values, creatinine clearance and pulmonary function tests. Since the chemotherapy can suppress spermatogenesis temporarily or, at higher doses, for longer times, an initial at least hormonal examination should be performed or cryoconservation be recommended to the patient. Most important is the performance of the therapy cycles at intervals of 21 days. Delays are only justified in cases of febrile neutropenia or thrombocytopenia < 100 000/nL. The generally accepted lower limiting value for leukocytes is not per se valid in cases of testicular cancer. In the case of pronounced myelosuppression a growth factor can be administered prophylactically prior to the next cycle. A sufficient consumption of water before and after administration of the drugs is important, an antiemetic agent is routinely mixed with infusions. It is also important to provide the patient with the necessary medication for a possible delayed vomiting. In the follow-up of patients after PEB late toxicities such as the occurrence of a second malignancy must be taken into consideration.
Written by:
Krege S. Are you the author?
Klinik für Urologie und Kinderurologie, Alexanier Krefeld Krankenhaus Maria Hilf, Krefeld.
Reference: Aktuelle Urol. 2012 Sep;43(5):342-5.
doi: 10.1055/s-0032-1323735
PubMed Abstract
PMID: 22996415
Article in German.
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