TIP

TIP is the name of a chemotherapy drug combination. It includes the drugs below. How to pronounce the drug names are in brackets.

• paclitaxel (pac-lik-tax-ul)
• ifosfamide (eye-foss-fa-mide)
• cisplatin (sis-pla-tin)

It is a treatment for testicular cancer that has spread or come back. It is sometimes used for a rare type of ovarian cancer called germ cell cancer.

How does TIP work?

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

How do you have TIP?

You have all drugs as a drip into your bloodstream (intravenously). 

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

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 each time you have treatment.

How often do you have TIP?

You usually have TIP 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 21 days (3 weeks). You have 4 to 6 cycles.

Exactly how you have your drugs may depend on your circumstances. The following is an example:

You then start the next treatment cycle. You might need to stay in hospital while you are having treatment with TIP.

Mesna

You also have the drug mesna, which is not chemotherapy. You have mesna as a continuous drip (infusion) into your vein. You might also have tablets to take home.

Mesna helps to stop the ifosfamide from irritating your bladder and making the lining bleed. You also need to have plenty of fluids to help keep your kidneys working normally.

GCSF injections

You might have growth factor injections to help your blood cell counts recover after treatment. This usually starts about a week after treatment, and you have a daily injection for 7 days.

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 TIP?

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. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

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:

Increased risk of getting an 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 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 nosebleeds

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.

Irritation of the bladder

This treatment can cause irritation of the bladder. Symptoms include:

• pain or burning when you pee
• urgency to go to the toilet
• needing to pee more often
• pink or red colour urine due to blood, you might also pass blood clots

You have another drug called mesna to help protect your bladder.

Talk to your team if you notice blood in your pee.

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.

Hair thinning

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. 

Some people may have permanent hair loss although this is very rare.

Diarrhoea

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Mouth sores and ulcers

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.

Numbness or tingling in fingers or toes

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

Pain in your muscles and joints

This might start a couple of days after treatment and last for about 5 days. Speak to your doctor or nurse about what painkillers you can take to help with this. 

Allergic reaction

You might have a mild allergic reaction during or shortly after your treatment. This could be a rash, itching or a red face.

Less commonly you might have breathing difficulties, fever and chills. Let your team know straight away if you are feeling unwell. They will slow down or stop your drip for a while.

Blood pressure changes

Your blood pressure might be lower than normal. Tell your doctor or nurse if you feel lightheaded or dizzy. You have your blood pressure checked regularly.

Rarely you might have high blood pressure.

Low levels of minerals in the blood

You might have low levels of sodium or magnesium. You will have regular blood tests to check for this.

High temperature (fever)

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

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:

• redness, swelling or leaking at the drip site

• liver changes that are mild and unlikely to cause symptoms. Rarely, you might have yellowing of the skin or whites of the eyes (jaundice).

• loss of appetite

• skin or nail problems such as dry or itchy skin, a rash, or irritation of the skin. Less commonly you might have severe peeling or blistering of the skin.

• blood clots that can be life threatening; signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these

• change in heart rate or rhythm. More rarely you might have heart problems such as enlarged heart, changes to the heart muscle, fluttering, heart failure, or a heart attack

• hearing problems - you might 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.

Rare side effects

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

• tiredness and weakness (fatigue) after treatment

• lung problems causing breathlessness and a cough. Rarely, this can be life threatening.

• tummy (abdominal) pain

• a second cancer such as acute leukaemia some time after treatment

• Stevens-Johnson syndrome - 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 could be life threatening.

• fits (seizures)

• posterior reversible encephalopathy syndrome (PRES) - a rare disorder of the nerves causing headache, fits, confusion and changes in vision - contact your health team straight away. This condition is reversible

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:

• soreness, redness, and peeling on palms of hands or soles of feet

• a blood clotting disorder called disseminated intravascular coagulation

• high levels of chemicals in your blood due to the breakdown of tumour cells (tumour lysis syndrome) - you have regular blood tests to check for this

• changes to your mental state such as panic attacks and not being able to speak

• changes to how your brain works

• changes to how you move and walk

• nerve changes causing burning, prickling sensation or a decrease in sensation and loss of muscle control causing flapping hands

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.

Pregnancy and contraception

This treatment may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment. Women must not become pregnant for at least 7 months after the end of treatment. 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 become pregnant while having treatment.

Loss of fertility

You may not be able to get someone pregnant after treatment with this drug. Talk to your doctor before starting treatment if you think you want to have a baby in the future. You may be able to store sperm before starting treatment.

Breastfeeding

Don’t breastfeed during this treatment and for 4 weeks after your last dose, because the drugs may come through into 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.