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EP (PE)

This page tells you about the chemotherapy drug combination EP, which is also known as PE. There is information about

 

What EP is

EP is the name of a combination of chemotherapy drugs used to treat several types of cancer, including 

  • Small cell lung cancer
  • Germ cell cancers – these most often occur in the ovary or testicle.
  • Small cell of the neck of the womb (cervix)

EP is made up of the drugs

  • E – Etoposide (also known as Vepesid, Eposin or Etopophos)
  • P – Cisplatin (sometimes called platinum)
 

How you have EP

Etoposide and cisplatin are colourless fluids. You have them into your bloodstream (intravenously). You can have them through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have them through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in before or during your course of treatment and it stays in place as long as you need it.

You can read our information about having chemotherapy into a vein.

Etoposide also comes as capsules that you swallow. You should swallow these whole with plenty of fluid and take them on an empty stomach. It is very important that you take capsules according to the instructions your doctor or pharmacist gives you. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first. Don’t take an extra capsule if you forget to take a dose.

You usually have EP chemotherapy as cycles of treatment. Each cycle lasts 3 weeks. You may have up to 6 cycles. 

For lung cancer you have each cycle of treatment in the following way

  • On the 1st day you have etoposide and cisplatin as a drip for a couple of hours
  • On the 2nd and 3rd days you have etoposide as a drip or you have it as capsules that you take at home for 4 days
  • You have no treatment for just over 2 weeks before starting the next cycle

For germ cell cancer of the ovary or testicle, you have each cycle of treatment in the following way

  • On the 1st day you have etoposide and cisplatin as a drip for a couple of hours
  • On the 2nd and 3rd days you have etoposide as a drip. In some hospitals you may also have a further 2 days of etoposide as a drip
  • You have no treatment for just over 2 weeks. Then you start the next cycle.

For small cell cervical cancer, you have each cycle in the following way

  • On the 1st, 2nd and 3rd days you have etoposide and cisplatin as a drip for a couple of hours
  • On the 4th and 5th days you have etoposide on its own as a drip
  • You have no treatment for 17 days. Then you start the next cycle.

Fluids

You will have fluids (sterile salt water or saline) into your drip before and after the EP drips. This helps to keep your kidneys working properly.

About side effects

The side effects associated with EP are listed below. You can use the underlined links to find out more about each one. For general information, see our cancer drugs side effects section or use the search box at the top of the page.

 

Common side effects

More than 10 in every 100 people have one or more of the side effects listed below.

  • An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C. You will have regular blood tests to check your blood cell levels
  • Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
  • Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechiae)
  • Hair loss happens to about 7 out of 10 people (70%) but is temporary
  • Tiredness affects in about 4 in 10 people (40%) during and after treatment. Most people find their energy levels are back to normal within 6 months to a year
  • Feeling or being sick is common but is usually well controlled with anti sickness medicines
  • Kidney changes that are mild and unlikely to cause symptoms. These will almost certainly go back to normal when treatment ends. You will have regular blood tests to check how well your kidneys are working
  • Hearing changes – you may not be able to hear some high pitched sounds or you may hear ringing in your ears (tinnitus). This usually gets better on its own
  • Taste changes or a metallic taste – this ends when you finish treatment
  • Inflammation at the drip site – if you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse straight away
  • A sore mouth
  • A drop in blood pressure – tell your nurse if you feel dizzy or faint while having the etoposide drip. They can help by slowing your drip down
  • Loss of appetite happens in 3 out of 10 people (30%)
  • Changes in bowel function affect between 1 and 2 out of 10 people (10 to 20%) – you may have diarrhoea or constipation
  • Women may stop having periods (amenorrhoea) – this may only be temporary
  • Loss of fertility – you may not be able to become pregnant or father a child after this treatment. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment
 

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.

  • A skin rash
  • Numbness or tingling in fingers and toes can cause difficulty with small things such as doing up buttons – this starts a few days or weeks after treatment and usually goes within a few months of treatment ending
  • Allergic reactions can happen while you are having these drugs into your bloodstream. Tell your nurse if you have skin rashes and itching, feel breathless, or have swelling of the face, lips or throat
 

Important points to remember

You may have a few of the side effects mentioned here. A side effect may get worse through your course of treatment. Or you may have more side effects as the course of treatment goes on. This depends on

  • How many times you've had a drug before
  • Your general health
  • How much of the drug you have (the dose)
  • The way you take the drug (capsules or drip)
  • Other drugs you are having

Coping with side effects

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Other medicines

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.

Pregnancy and contraception

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

Breastfeeding

Do not breastfeed during this treatment because the drugs may come through in the breast milk.

 

Immunisations and chemotherapy

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.

 

More information about EP drugs

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.

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Updated: 30 March 2015