Cisplatin, etoposide and ifosfamide (VIP)

VIP is a combination of chemotherapy drugs used to treat testicular cancer that has spread or come back. It is also called PEI or IPE. 

It is made up of the following drugs: 

  • cisplatin
  • etoposide
  • ifosfamide

How VIP works

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.

How you have VIP

You have these drugs as a drip into the bloodstream (intravenous).

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

  • central line
  • PICC line
  • portacath

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

When you have VIP

You have VIP chemotherapy as cycles of treatment. This means that you have the drug and then a rest to allow your body to recover.

Each cycle of treatment lasts 3 weeks (21 days). You usually have 4 cycles, taking about 3 months in total.

You usually have VIP in the following way. 

Day 1 to 5
  • You have etoposide as a drip into your bloodstream over an hour.
  • You have cisplatin as a drip into your bloodstream over 1 to 2 hours.
  • You have ifosfamide as a drip into your bloodstream over 1 to 4 hours.
Day 6 to 21
  • You have no treatment

You then start the next treatment cycle. 

Mesna and GCSF injections

You usually have ifosfamide together with another drug called mesna. You have mesna as a continuous drip (infusion) into your vein. You might also have tablets to take home. 

When having mesna you should drink about 2 litres (3½ pints) of water over 24 hours.

Mesna is not a chemotherapy drug. It stops the ifosfamide from irritating your bladder lining and making it bleed. You usually have mesna from day 1 to day 5 of each treatment cycle. 

You might also have injections of a drug called GCSF with each treatment. This is a type of growth factor that makes the body produce white blood cells to try to reduce the risk of infections. You have GCSF as an injection just under the skin (subcutaneously). This usually starts on day 6 of each treatment cycle. 

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Risk of bruising and bleeding

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Low level of sodium in the blood

You may have changes in levels of minerals and salts in your blood, such as low sodium. This will most likely go back to normal when you finish treatment. You have regular blood tests during treatment to check this.

Tummy (abdominal) pain

Tell your treatment team if you have this. They can check the cause and give you medicine to help. 

Loss of appetite

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Constipation or diarrhoea

Tell your doctor or nurse if you have diarrhoea or constipation. They can give you medicine to help. 

Changes to how well your liver works

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Skin changes

Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. Your nurse will tell you what products you can use on your skin to help.

The colour of your skin might also change.

Tiredness and weakness (fatigue)

Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Loss of hearing

Your hearing might be affected including loss of hearing. Tell your doctor or nurse if your hearing changes. 

Numbness, tingling or pain in hands or feet

Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your doctor if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons. 

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

  • an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness - some allergic reactions can be life-threatening alert your nurse or doctor if notice any of these symptoms
  • a blood clot in the deep veins of your body (deep vein thrombosis, DVT) that could possibly travel to your lungs (pulmonary embolism). This could be life threatening if not treated quickly
  • a serious reaction to an infection (sepsis) signs can include feeling very unwell, not passing urine, being sick, a very high or very low temperature or shivering - contact your advice line straight away if you have any of these symptoms
  • low blood pressure (hypotension) or high blood pressure (hypertension)
  • dizziness
  • a second cancer called acute leukaemia
  • inflammation and or ulcers of the mouth, throat and or food pipe (oesophagus)
  • inflammation around the drip site which can cause pain and swelling
  • heart problems such as slow, fast or irregular heartbeat

Rare side effects

These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:

  • a low level of magnesium in the blood
  • problems with hearing such as ringing in the ears (tinnitus) or loss of hearing
  • numbness, tingling or pain in the hands or feet (peripheral neuropathy)

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medications, foods and drinks

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Loss of fertility

You may not be able to become pregnant or father a child after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Contraception and pregnancy

This treatment may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment. Talk to your doctor or nurse about effective contraception before starting treatment.

Women must not become pregnant for at least a year after the end of treatment. Men should not father a child for at least 6 months after treatment. 

Breastfeeding

Don’t breastfeed during this treatment because the drugs may come through in your breast milk.

Other treatments

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisation

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

  • other vaccines, but they might not give you as much protection as usual
  • the flu vaccine (as an injection)
  • the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system Open a glossary item recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Related links