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Systemic Anti-Cancer Therapy Regimen Library

Home > GYN Ovarian germ cell tumour - BEP [bleomycin, etoposide and cISplatin]

GYN Ovarian germ cell tumour - BEP [bleomycin, etoposide and cISplatin]

Treatment Overview

Give 3 or 4 cycles depending on risk. 

Cycles 1 to 4 - 21 days

Cycle length:
21

Emetogenicity: HIGH days 1 to 5; MINIMAL day 8 and 15.

Cycle details

Cycles 1 to 4 - 21 days

Medication Dose Route Days Max Duration
olanzapine * 5 mg oral administration 1 to 8
aprepitant 125 mg oral administration 1
aprepitant 80 mg oral administration 2, 3
dexamethasone * 12 mg oral administration 1
dexamethasone * 8 mg oral administration 2 to 8
ondansetron 8 mg oral administration 1 to 5
hydrocortisone 100 mg intravenous 15 2 minutes
bleomycin * 30000 international unit flat dosing intravenous 1, 8, 15 10 minutes
magnesium sulfate heptahydrate 10 mmol intravenous 1 to 5 60 minutes
cISplatin 20 mg/m² intravenous 1 to 5 60 minutes
sodium chloride 0.9 % intravenous 1 to 5 60 minutes
etoposide (as phosphate) * 100 mg/m² intravenous 1 to 5 60 minutes
ondansetron 8 mg oral administration 1 to 5
cycliZINE 50 mg Three times daily oral administration 1
docusate sodium + sennoside B 2 Tablet(s) oral administration 1

Emetogenicity: HIGH days 1 to 5; MINIMAL day 8 and 15.

Full details

Cycles 1 to 4 - 21 days

Day: 1

Medication Dose Route Max duration Details
olanzapine * 5 mg oral administration
Instructions:
ONE hour prior to chemotherapy. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. Some centres may choose to omit pre-chemotherapy dose or advise patient to take the night before chemotherapy if patient has to drive to appointment.
aprepitant 125 mg oral administration
Instructions:
ONE hour prior to chemotherapy.
dexamethasone * 12 mg oral administration
Instructions:
ONE hour prior to chemotherapy with food.
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy.
bleomycin * 30000 international unit flat dosing intravenous 10 minutes
Instructions:
High risk of febrile infusion reaction.
magnesium sulfate heptahydrate 10 mmol intravenous 60 minutes
Instructions:
In 1000 mL of sodium chloride 0.9%, prior to cISplatin infusion.
cISplatin 20 mg/m² intravenous 60 minutes
Instructions:
In 500 - 1000 mL of sodium chloride 0.9%, depending on stability. Ensure patient has passed urine as per institutional policy. Hypersensitivity risk increases with number of cycles of cISplatin.
sodium chloride 0.9 % intravenous 60 minutes
Quantity:1000 mL
Instructions:
After cISplatin infusion. If cISplatin is infused in 1000 mL, centres may choose to omit this bag of fluid.
etoposide (as phosphate) * 100 mg/m² intravenous 60 minutes
ondansetron 8 mg oral administration
Instructions:
EIGHT hours after chemotherapy OR before bed.
cycliZINE 50 mg Three times daily oral administration
Instructions:
When required for nausea and/or vomiting. Warning: may cause drowsiness. Consider starting dose at 25 mg and increasing as tolerated/required. The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics. Note that domperidone is not recommended in combination with olanzapine and ondansetron due to potential risk of QT prolongation.
docusate sodium + sennoside B 2 Tablet(s) oral administration
Instructions:
At night when required for constipation. Each tablet contains docusate sodium 50 mg + sennoside B 8 mg.

Day: 2

Medication Dose Route Max duration Details
olanzapine * 5 mg oral administration
Instructions:
ONCE daily. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
aprepitant 80 mg oral administration
Instructions:
ONCE daily in the morning.
dexamethasone * 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy with food in the morning. Dose and duration may be individualised at clinician’s discretion.
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy.
magnesium sulfate heptahydrate 10 mmol intravenous 60 minutes
Instructions:
In 1000 mL of sodium chloride 0.9%, prior to cISplatin infusion.
cISplatin 20 mg/m² intravenous 60 minutes
Instructions:
In 500 - 1000 mL of sodium chloride 0.9%, depending on stability. Ensure patient has passed urine as per institutional policy. Hypersensitivity risk increases with number of cycles of cISplatin.
sodium chloride 0.9 % intravenous 60 minutes
Quantity:1000 mL
Instructions:
After cISplatin infusion. If cISplatin is infused in 1000 mL, centres may choose to omit this bag of fluid.
etoposide (as phosphate) * 100 mg/m² intravenous 60 minutes
ondansetron 8 mg oral administration
Instructions:
EIGHT hours after chemotherapy OR before bed.

Day: 3

Medication Dose Route Max duration Details
olanzapine * 5 mg oral administration
Instructions:
ONCE daily. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
aprepitant 80 mg oral administration
Instructions:
ONCE daily in the morning.
dexamethasone * 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy with food in the morning. Dose and duration may be individualised at clinician’s discretion.
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy.
magnesium sulfate heptahydrate 10 mmol intravenous 60 minutes
Instructions:
In 1000 mL of sodium chloride 0.9%, prior to cISplatin infusion.
cISplatin 20 mg/m² intravenous 60 minutes
Instructions:
In 500 - 1000 mL of sodium chloride 0.9%, depending on stability. Ensure patient has passed urine as per institutional policy. Hypersensitivity risk increases with number of cycles of cISplatin.
sodium chloride 0.9 % intravenous 60 minutes
Quantity:1000 mL
Instructions:
After cISplatin infusion. If cISplatin is infused in 1000 mL, centres may choose to omit this bag of fluid.
etoposide (as phosphate) * 100 mg/m² intravenous 60 minutes
ondansetron 8 mg oral administration
Instructions:
EIGHT hours after chemotherapy OR before bed.

Day: 4

Medication Dose Route Max duration Details
olanzapine * 5 mg oral administration
Instructions:
ONCE daily. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
dexamethasone * 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy with food in the morning. Dose and duration may be individualised at clinician’s discretion.
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy.
magnesium sulfate heptahydrate 10 mmol intravenous 60 minutes
Instructions:
In 1000 mL of sodium chloride 0.9%, prior to cISplatin infusion.
cISplatin 20 mg/m² intravenous 60 minutes
Instructions:
In 500 - 1000 mL of sodium chloride 0.9%, depending on stability. Ensure patient has passed urine as per institutional policy. Hypersensitivity risk increases with number of cycles of cISplatin.
sodium chloride 0.9 % intravenous 60 minutes
Quantity:1000 mL
Instructions:
After cISplatin infusion. If cISplatin is infused in 1000 mL, centres may choose to omit this bag of fluid.
etoposide (as phosphate) * 100 mg/m² intravenous 60 minutes
ondansetron 8 mg oral administration
Instructions:
EIGHT hours after chemotherapy OR before bed.

Day: 5

Medication Dose Route Max duration Details
olanzapine * 5 mg oral administration
Instructions:
ONCE daily. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
dexamethasone * 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy with food in the morning. Dose and duration may be individualised at clinician’s discretion.
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy.
magnesium sulfate heptahydrate 10 mmol intravenous 60 minutes
Instructions:
In 1000 mL of sodium chloride 0.9%, prior to cISplatin infusion.
cISplatin 20 mg/m² intravenous 60 minutes
Instructions:
In 500 - 1000 mL of sodium chloride 0.9%, depending on stability. Ensure patient has passed urine as per institutional policy. Hypersensitivity risk increases with number of cycles of cISplatin.
sodium chloride 0.9 % intravenous 60 minutes
Quantity:1000 mL
Instructions:
After cISplatin infusion. If cISplatin is infused in 1000 mL, centres may choose to omit this bag of fluid.
etoposide (as phosphate) * 100 mg/m² intravenous 60 minutes
ondansetron 8 mg oral administration
Instructions:
EIGHT hours after chemotherapy OR before bed.

Day: 6

Medication Dose Route Max duration Details
olanzapine * 5 mg oral administration
Instructions:
ONCE daily. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
dexamethasone * 8 mg oral administration
Instructions:
ONCE daily in the morning with food. Dose and duration may be individualised at clinician’s discretion.

Day: 7

Medication Dose Route Max duration Details
olanzapine * 5 mg oral administration
Instructions:
ONCE daily. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
dexamethasone * 8 mg oral administration
Instructions:
ONCE daily in the morning with food. Dose and duration may be individualised at clinician’s discretion.

Day: 8

Medication Dose Route Max duration Details
olanzapine * 5 mg oral administration
Instructions:
ONCE daily. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
dexamethasone * 8 mg oral administration
Instructions:
ONE hour prior to bleomycin with food.
bleomycin * 30000 international unit flat dosing intravenous 10 minutes
Instructions:
High risk of febrile infusion reaction.

Day: 15

Medication Dose Route Max duration Details
hydrocortisone 100 mg intravenous 2 minutes
Instructions:
30 minutes prior to bleomycin if a patient had previous febrile reaction or as per institutional practice.
bleomycin * 30000 international unit flat dosing intravenous 10 minutes
Instructions:
High risk of febrile infusion reaction.

Supportive Care Factors

Factor Value
Constipation risk: laxatives are usually prescribed
Emetogenicity: Variable
Hydration: Routine hydration recommended
Hypersensitivity / Infusion related reaction risk: High - routine premedication recommended

References

Aapro, M. S., J. Bohlius, D. A. Cameron, et al. 2011. "2010 update of EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphoproliferative disorders and solid tumours." Eur J Cancer 47(1):8-32., PMID: 21095116

Williams, S. D., J. A. Blessing, K. D. Hatch, et al. 1991. "Chemotherapy of advanced dysgerminoma: trials of the Gynecologic Oncology Group." J Clin Oncol 9(11):1950-1955., PMID: 1719142

Segelov, E., J. Campbell, M. Ng, et al. 1994. "Cisplatin-based chemotherapy for ovarian germ cell malignancies: the Australian experience." J Clin Oncol. 12(2):378-384., PMID: 8113845

Boulanger J, Boursiquot JN, Cournoyer G, et al. Management of hypersensitivity to platinum- and taxane-based chemotherapy: cepo review and clinical recommendations. Curr Oncol. 2014;21(4):e630-e641. , PMID: 25089112

Castells, M.C., Matulonis, U.A., and Horton, TM. Infusion reactions to systemic chemotherapy. Savarese DMF and Feldweg AM, ed. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com/contents/infusion-reactions-to-systemic-chemotherapy (Accessed 26 March 2021).

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.