Would you recommend VIP x 4 cycles over EP x 4 cycles in a patient with good risk Stage IIIB seminoma but an elevated LDH over 5x upper limit of normal with a 20 pack year smoking history?  

So I would not automatically rule out BEP X 3 just because he has a history of smoking. I would look at his age and renal function. If he is younger than 40-45 with good renal function and normal diffusion capacity, I would give him BEP X 3 and check him with each dose of bleo regarding the history ...