Chemotherapy (BEP) and the CAA

[beacon.outbound]

Hi all

Was diagnosed with testicular cancer a couple of weeks ago and had the op a few days later. I have just had my initial appointment with the oncologist today, who has recommended 1 cycle of adjuvant chemotherapy consisting of Bleomycin, Etoposid and Cisplatin (BEP)

The oncologist however raised the issue asking if the CAA have any objections to the use of Bleomycin? The reason he asks is that apparently Bleomycin can have some side effects on the lungs..

The alternative would be to have 2 cycles of EP.

Just wondering if if anyone here has been through chemo for TC, and whether of not they had issues with the Bleomycin affecting their Class One medical?

Thanks

[wiggy]

Forgive me if you have seen this, but just in case you haven’t, there’s generic guidance here:

https://www.caa.co.uk/Aeromedical-Examiners/Medical-standards/Pilots-(EASA)/Conditions/Oncology/Oncology-guidance-material-GM/

Chemo involving anthracycline seems to be the big problem.

Good Luck.

[beacon.outbound]

Thanks, wiggy. No specific mention of bleomycin so that’s promising.

Interesting to note that bleomycin is not given to people who scuba dive as it *can* affect lung capacity.

[che ci dò che ci dò!]

I had the same diagnosis 8 years ago, but I did have lymphnodal methastasis, stage II.
In my case, protocol would have been 3 rounds of PEB. Oncologist told me there was an alternative protocol, 4 stages instead of 3, with platinum and etopside, without bleomicin.
Got cured and all clear ever since!
Try to ask your oncologist, there must be something similar, like 2 rounds instead of 1, with no bleomicin

[beacon.outbound]

Thanks for your input, and glad that you are doing well 8 years down the line!

I have had a bit more progress with the CAA. According to my AME the CAA used to list Bleomycin as disqualifying. However they have recently had a change of heart and now they allow Bleomycin with that warning that it could have implications on the Class 1 Medical.

My oncologist states that with a single dose of Bleomycin then his estimates are 1/1000 chance of having a detrimental effect on lung capacity.

Have also contacted Dr. Einhorn who to all intents and purposes “invented” the BEP regimen and his view is that there should be “zero effect” on flying.

Looks like I’ll be taking the plunge and going for the BEP.

I’ll keep this thread updated, in case anyone else in the future has the misfortune of needing this information.

[che ci dò che ci dò!]

Have a colleague who had khoriocarcinoma with lungs metastasis, the most aggressive, he had to go through 5 rounds of high dosage, including bleomycin (he had no choice), and after that he also had to go through RPLND.
Got his class 1 back, initially with OML etc, but now, after many years, he's unrestricted class 1
In my case, as I could choose, I did avoid bleo, but you see, even in case you have to do it, it doens't mean necessarily that it's disqualifying.

[beacon.outbound]

That is promising, thank you. May I ask what OML restrictions you had to comply with when you returned to work? Also, how long did it take you to get your Class 1 back after finishing your last round of chemo?

[che ci dò che ci dò!]

That is promising, thank you. May I ask what OML restrictions you had to comply with when you returned to work? Also, how long did it take you to get your Class 1 back after finishing your last round of chemo?

OML stands for "operational multi pilot". Basically the other pilot you fly with, must have an unrestricted medical.
I got this limitation removed after 2 years.
If I remember well, after chemo, you must wait for at least 1 month to unertake a medical examination, and of course your blood cell count must be normal, as well as liver and kidneys function tests.
With cisplatin, it could happen that your liver function tests are elevated for several months after therapy.
In case you have to undergo a RPLND, as it's an abdominal surgery, you can go through a class 1 examination only after a minimum period of 3 months
Hope this helps

[beacon.outbound]

Very helpful- thank you for all the info!

[beacon.outbound]

Useful info- thanks Nick.

[beacon.outbound]

Hi folks. Been a while. I promised to keep this thread updated so here goes. Finished my one cycle of BEP chemotherapy summer 2019. No drastic side effects to start with however this turned into many many months of pretty terrible fatigue; yes much worse than any summer flying schedule. On a whim, my Vitamin-D was eventually tested and found to be virtually non-existent (apparently some studies indicate BEP chemo can zap this out of you). Course of high-dosage supplements and a few months later I was feeling much better.



My biggest concern before starting treatment was the Bleomycin and how it can have a detrimental effect on lung capacity. Thankfully this did not materialise and my lungs were not affected whatsoever. It’s interesting that up until recent years that Bleomycin was a “disqualifying” medication in the eyes of the CAA. Some AMEs have old literature about this so they might require a gentle prod to check with the CAA if they still tell you it’s disqualifying.



CAA accepted the “15 point report” kindly written up by my oncologist, reinstating my medical with an OML applied for 2 years from the date my chemotherapy ended.


More than happy to discuss in more detail and give advice should anyone be in the unfortunate position of having a recent diagnosis.

[Alsacienne]

beacon.outbound, this is a very brave series of posts and I am delighted to hear that you are back to flying ... and living a full life (even in today's testing times). Thank you for posting, and all the very best.

[beacon.outbound]

beacon.outbound, this is a very brave series of posts and I am delighted to hear that you are back to flying ... and living a full life (even in today's testing times). Thank you for posting, and all the very best.

Thank you. Wishing you all the best as well!