Indication:
- Standard first-line chemotherapy for germ cell tumors, particularly testicular cancer (seminoma and non-seminomatous)
- Used in good, intermediate, and poor-risk metastatic disease
Drug Components and Schedule
| Drug | Dose and Schedule | Route |
|---|---|---|
| Bleomycin | 30 units on Days 1, 8, and 15 | IV |
| Etoposide | 100 mg/m² on Days 1–5 | IV |
| Cisplatin | 20 mg/m² on Days 1–5 | IV |
| Cycle Length: 21 days, typically 3–4 cycles depending on risk group |
Key Toxicities:
| Agent | Major Toxicities |
|---|---|
| Bleomycin | Pulmonary toxicity (dose-limiting), fever/chills |
| Etoposide | Myelosuppression, alopecia, mucositis |
| Cisplatin | Nephrotoxicity, ototoxicity, neurotoxicity, severe N/V |
Monitoring Parameters
- Bleomycin:
- Baseline and periodic PFTs (DLCO)
- Track cumulative dose (limit ~400 units)
- Avoid G-CSF due to increased risk of pulmonary fibrosis
- Cisplatin:
- Pre- and post-hydration, monitor renal function, electrolytes (Mg²⁺, K⁺)
- Use aggressive antiemetics (cisplatin is highly emetogenic)
- Etoposide:
- CBC, monitor for neutropenia and risk of febrile neutropenia