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 next to each drug we have how you pronounce it in brackets: 

• cisplatin (sis-plat-in)
• etoposide (ee-top-o-side)
• ifosfamide (eye-foss-fa-mide)

How does VIP work?

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

How do 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

How often do 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. 

You then start the next treatment cycle. You have fluids into your bloodstream for a few hours before and after each cisplatin treatment. You also should drink about 2 litres (3½ pints) of water over 24 hours . The extra fluids help to protect your kidneys.

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.

You have regular urine tests before and during treatment. This is to check if the ifosfamide is affecting the bladder.

What are the side effects of VIP?

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 (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 while 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. 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.

Constipation or diarrhoea

Tell your healthcare team 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, 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. 

Skin changes

Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. Your healthcare team can 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.

High temperature

Tell your healthcare team straightaway if you get a high temperature. 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:

• 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 clots that could 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 symptoms.

• a serious reaction to an infection. 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 or high blood pressure

• dizziness

• a blood cancer called acute leukaemia. Talk to your doctor if this of concern to you.

• 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

• shortness of breath

• lung problems such as pneumonia and difficulty breathing

• mental state changes such as not speaking, confusion, panic and anxiety

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. Tell your team if this is happening.

• numbness, tingling or pain in the hands or feet (peripheral neuropathy)

• taste of metal or feeling like the gums are metal

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:

• chills

• swelling

• muscle twitching

• bone, muscle and joint pain

• breakdown of the muscle which can be life threatening or cause permanent damage. Symptoms include muscle pain, muscle weakness, trouble moving arms and legs, red or brown urine or urinating less. Contact your team if you have any of these symptoms.

• softening of the bones

• nail changes

• excessive sweating

• 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.

• eye problems such as watery, redness and itchy (conjunctivitis)

• problems with your eyesight

• changes to the 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.

• SIADH. This is a syndrome where the body makes too much of the hormone that holds water in the body.

• kidneys stop working (renal failure)

If you have side effects that aren't listed on this page, you can look at the individual drug pages:

• cisplatin
• etoposide
• ifosfamide

Coping with side effects

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

What else do you need to know?

Other medications, foods and drinks

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 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 get someone pregnant while you are having treatment. Women must not become pregnant for at least a year 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.

Breastfeeding

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

Other treatments

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

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 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.