Feldman Discusses Standard of Care for Testicular Cancer

Darren R. Feldman, MD, a medical oncologist and chair of Quality Assurance, in the Department of Medicine at Memorial Sloan Kettering Cancer Center, discusses the standard of care for the treatment of testicular cancer.

According to Feldman, the standard of care for patients with intermediate or poor risk germ cell tumors is 4 cycles of BEP, which includes bleomycin, etoposide, and cisplatin. This triplet has been used since 1987.

However, some patients are not eligible for bleomycin due to its potential pulmonary toxicity. This may include patients who are active smokers, who are older, or who have renal insufficiency. According to Feldman, these patients may receive a non-bleomycin regimen such as the combination of is etoposide, ifosfamide, and cisplatin.

0:08 | The mainstay of treatment for patients with advanced intermediate or poor risk germ cell tumors is 4 cycles of a triple combination chemotherapy regimen known as bleomycin, etoposide, cisplatin or BEP. And that's been the standard regimen that we've used since back in 1987. So that remains the standard of care. There are some patients who are not candidates for bleomycin, which has may have a side effects as pulmonary toxicity. So, patients who are on oxygen therapy to begin at the time of beginning their treatment might not be good candidates for bleomycin. Patients who are active smokers and patients who are older, who have renal insufficiency, since the kidney is responsible for excreting bleomycin, those patients may be at higher risk for lung toxicity. And we would err on the side of using a non-bleomycin containing regimen such as VIP which is etoposide, ifosfamide, and cisplatin.