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Genitourinary Cancers • Medical Oncology
Is there a lung metastasis size cut-off do you suggest for selecting between BEP and VIP as initial chemotherapy in advanced testicular cancer?
UpToDate indicates that VIP is an alternative to BEP for men who are not candidates for bleomycin, and that one criteria for not being such a candidate for bleomycin includes having "Bulky lung metastases that may require postchemotherapy resection."
One clinical trial describes bulky lung metastases as 2-5 cm in size, but the study also describes these men as successfully being treated with bleomycin:
Answer from: Medical Oncologist at Community Practice
I do not use a size cut off to select initial chemotherapy regimen for advanced testicular cancer. I rather use the International Germ Cell Cancer Collaborative Group (IGCCCG) model for initial risk stratification. Irrespective of risks, BEP is considered standard initial regimen. Nevertheless, for ...
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Answer from: Medical Oncologist at Academic Institution
I believe bleomycin is still preferred in view of this having the largest datasets and longer follow up survival data. In similar situations in my practice, I have utilized baseline PFTs and DLCO to guide choice of bleomycin. For example, in a heavy smoker with baseline DLC < 60, I would prefer V...