BEP
Meaning of BEP: Three drugs behind one of the great successes in cancer treatment, and a regimen whose limits are set by its own side effects.
Definition of BEP
BEP is a chemotherapy combination of bleomycin, etoposide and cisplatin, given in repeated cycles for germ cell tumors of the testis and ovary. The letters come from bleomycin, etoposide and Platinol, the brand name under which cisplatin was sold. The regimen turned a group of cancers that were usually fatal once advanced into ones that are usually cured.
What does each drug do?
| Letter | Drug | How it acts | Signature toxicity |
|---|---|---|---|
| B | Bleomycin | Cuts DNA strands using iron and oxygen | Scarring of the lungs |
| E | Etoposide | Traps the enzyme that unwinds DNA, leaving breaks | Marrow suppression, later leukemia in rare cases |
| P | Cisplatin | Links DNA strands so they cannot separate | Kidney damage, hearing loss, nerve damage, nausea |
Cisplatin is the drug that made the difference and the other two are built around it. Germ cell tumors are unusually sensitive to platinum because their cells repair this kind of DNA damage poorly and die once it accumulates, a weakness most adult cancers do not share.
What is it used for?
Germ cell tumors, mainly of the testis, along with the same tumor types arising in the ovary or at midline sites outside the gonads. The number of cycles is set by risk group, and a full course is short by the standards of cancer treatment. Cure is expected even where disease has reached the lungs or liver, which is why testicular cancer serves as the standard example of a curable advanced solid tumor.
Why is bleomycin the limiting drug?
It scars lung tissue and the damage does not reverse. Risk climbs with the total dose given, with age, with impaired kidney clearance and with smoking. Breathing tests are followed during treatment and the drug is withdrawn if lung function falls or a dry cough and breathlessness appear. Because lungs exposed to bleomycin react badly to high oxygen concentrations, that exposure is recorded for any later anesthetic. An alternative regimen leaving it out exists for people at particular risk.
What happens after treatment?
Masses often remain on scans once combination chemotherapy ends, and they are not assumed to be dead tissue. A mass that persists after markers have returned to normal is frequently removed, because it may contain mature teratoma, which chemotherapy cannot kill and which can keep growing or turn malignant. Follow up also watches for effects surfacing years later: reduced fertility, hearing loss, numbness in the hands and feet, impaired kidney function and a raised risk of heart disease.
Also known as
Used in a sentence
Three cycles of BEP were given for a good risk germ cell tumor.
Good to know
Previous bleomycin exposure is recorded permanently, because lung tissue it has scarred reacts badly to high oxygen concentrations during later anesthesia and the scarring does not reverse.