VeIP

VeIP is the name of a chemotherapy drug combination. It includes the drugs we list below, next to each drug we have how you pronounce the drug name in brackets.

• Ve – vinblastine (vin-blas-teen)
• I – ifosfamide (eye-foss-fa-mide)
• P – cisplatin (sis-pla-tin)

It is a treatment for testicular cancer that has spread or come back.

How does VeIP work?

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

How do you have VeIP?

You have VeIP into your bloodstream (intravenously).

You 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

If you don't have a central line

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

When do you have VeIP?

You have VeIP 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 21 days (3 weeks). You might have up to 4 cycles of VeIP, taking around 3 months in total.

You may need to stay in hospital for the first 5 days of each cycle.

You might have VeIP in the following way:

You also have fluids and a drug called mesna. You have this as a drip into your bloodstream. Mesna isn't chemotherapy. It helps to stop the ifosfamide from irritating your bladder and making it bleed. 

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.

What are the side effects of VeIP?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you 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. 

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 (10%). You might have one or more of them. They include:

Increased 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. 

High temperature (fever)

If you get a high temperature, let your healthcare team know straight away. Ask them if you can take paracetamol to help lower your temperature.

Breathlessness and looking pale

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

Bruising, bleeding gums or nose bleeds

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).

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also 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 treat it once it has started.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs 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. 

 Kidney damage

To help prevent kidney damage, it is important to drink plenty of water. You might also have fluids into your vein before, during and after treatment. You have blood tests before your treatments to check how well your kidneys are working.

Inflammation and irritation of the bladder

Ifosfamide can cause inflammation and bleeding of the bladder lining. This is called haemorrhagic cystitis. This can cause you to:

• pass urine more often than usual
• find it difficult to pass urine
• have a burning feeling or pain when you go
• not be able to wait when you need to go
• pass blood or blood clots 

It helps to drink plenty of fluids. 

Tell your nurse or doctor straight away if you have any problems passing urine.

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 appetite and weight loss

You might not feel like eating and may lose weight. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss. 

Changes in levels of minerals in your blood

You may have changes in levels of minerals and salts in your blood, including low levels of sodium or high levels of uric acid (causing gout). You might also have low magnesium but this is rare.

You have regular blood tests during treatment to check this.

Changes to your hearing

You might have some changes in your hearing. You might uncommonly have some hearing loss, especially with high pitched sounds. You might also have some ringing in your ears (tinnitus). Tell your doctor or nurse if you notice any changes.

Occasional side effects

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

• a severe whole body infection that can be life threatening (sepsis)
• heart problems such as slow, fast or irregular heartbeat – rarely this can cause a heart attack
• lung problems such as shortness of breath, pneumonia , or difficulty breathing
• liver changes – these are usually mild and unlikely to cause symptoms, you have regular blood tests to check for changes
• swelling and pain around the drip site
• numbness and tingling in the fingers and toes
• metallic taste in your mouth
• blood clots that are life threatening; signs are pain, swelling and redness where the clot is. Feeling breathless can be a sign of a blood clot on the lung. Contact your advice line or doctor straight away if you have any of these symptoms

Rare side effects

These side effects happen in fewer than 1 in 100 people (1%). 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
• a second cancer called acute leukaemia
• headaches
• low blood pressure
• skin problems that can cause rash, dry skin, itching and blistering
• sore mouth or mouth ulcers
• nervous system problems such as seizures

Other side effects

There isn’t enough information to work out how often these side effects might happen. You might have one or more of them. They include:

• high blood pressure
• changes in your mental state – including feeling anxious or depressed
• pain in your muscles, bones and tumour site
• loss of reflexes
• feeling very thirsty and dry mouth
• high levels of uric acid and other substances in your body caused by the break down of tumour cells
• difficulty controlling your bowels
• difficulty speaking
• problems with your balance
• redness of the skin
• soreness, redness, peeling on palms and soles of the feet
• a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening
• constipation
• stroke
• headache
• dizziness
• bleeding from your back passage (rectum) or from a stomach ulcer
• lack of movement in the intestines
• build up of fluid in the body
• changes in sensation from touch or temperature
• changes to your vision or irritated, watery eyes
• flushing
• nail problems
• periods stopping
• dehydration

We have more information about the side effects of individual drugs:

• vinblastine 
• ifosfamide
• cisplatin 

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 medicines, foods and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Loss of fertility 

You may not be able to become pregnant or get someone pregnant 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 for at least 12 months afterwards. And men should not get someone pregnant for at least 6 months after treatment.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner falls pregnant while having treatment.

Breastfeeding 

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

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

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 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. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

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 and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

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