This page tells you about the chemotherapy drug combination TIP for testicular cancer and its possible side effects. There is information about
TIP is the name of a combination of chemotherapy drugs used to treat testicular cancer that has spread or come back. It is made up of the drugs
- T = pacliTaxel
- I = ifosfamide
- P = cisPlatin
You usually have TIP chemotherapy as cycles of treatment. Each cycle of treatment lasts 3 weeks. You have 4 to 6 cycles, taking 3 to 4½ months in total.
You have the drug injections into your bloodstream (intravenously). There are a few ways of doing this. You may have a small tube put into your arm or hand, called a cannula. Or you may have the drugs through a central line, a portacath or PICC line. These are long, plastic tubes that go into a large vein in your chest. The tube stays in place as long as you need it.
- On the first day of treatment you have paclitaxel as a drip over 3 hours. This is followed by the cisplatin over 4 hours and then ifosfamide over 2 hours
- For the next 4 days (days 2 to 5) you have ifosfamide and cisplatin in the same way as on the first day. You also have the drug mesna, which is not chemotherapy. 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. You may need to stay in hospital while you are having treatment
- For the next 2 weeks (days 6 to 21) you have no treatment.
- You then start the next treatment cycle
The side effects of a combination of drugs are usually a mixture of those of each drug. The combination may increase or decrease your chance of getting each side effect or it may change the severity. The side effects associated with TIP are listed below. You can use the underlined links to find out more about each one. For general information, see our side effects of cancer drugs section.
More than 10 in every 100 people have one or more of these effects.
- 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 may have injections of a drug called G-CSF to increase your white blood cell levels and reduce your risk of getting infections. Your doctor will check your blood counts regularly
- 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 petechia)
- Tiredness and weakness (fatigue) 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 usually well controlled with anti sickness medicines
- Kidney damage – you will have blood tests before your treatment, to make sure your kidneys are able to cope with the drug. To help prevent damage it is important to drink plenty of water. You will also have fluids into your vein before and after treatment
- You may have some hearing loss, especially with high pitched sounds
- Ringing in the ears (tinnitus) happens in about 3 in 10 people (30%) – this nearly always gets better on its own
- Hair loss – most people have complete hair loss. The hair will grow back once the treatment ends
- Diarrhoea or constipation – drink plenty of fluids and let your nurse or doctor know if the diarrhoea or constipation is severe or lasts for more than 3 days
- A sore mouth and tongue swelling
- Numbness or tingling in fingers and toes can cause difficulty with fiddly things such as doing up buttons – this starts within a few days or weeks and usually goes within a few months of finishing treatment. Some people may have permanent numbness
- Aching joints (arthralgia) and muscles (myalgia) affects about 6 out of 10 people (60%) – it may start a couple of days after treatment and last for about 5 days
- Mild allergic reactions occur in more than 3 out of 10 people (34%) – this usually shows as a rash or a red face. Let your doctor or nurse know if you have this
- Low blood pressure during the treatment – your nurse will check your blood pressure regularly
- Skin changes, including reddening or darkening of your skin
- Nail changes
- Loss of taste or a metallic taste may occur
- Loss of appetite
- About 12 out of 100 people (12%) have confusion, sleepiness or extreme lack of energy (lethargy) and hallucinations – if you have any of these, it is important to tell your doctor or nurse straight away
Between 1 and 10 in every 100 people have one or more of these effects.
- Inflammation around the drip site – if you notice any signs of redness, pain, swelling or leaking at your drip site, tell your nurse straight away
- Irritation of the bladder and kidneys – drink as much water as possible to flush out the drugs. You may have fluids into your drip before and after your treatment. You will have a drug called mesna to protect your bladder and kidneys. Make sure that you pass urine often and before you go to sleep
- Liver changes that are very 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 liver is working
- Loss of fertility – you may not be able to father a child after treatment with this drug. Talk to your doctor before starting treatment if you plan to have a baby in the future. You may be able to store sperm before starting treatment
- Abdominal (tummy) pain
Fewer than 1 in 100 people have these effects.
- Some people have a severe allergic reaction while having TIP treatment, usually at the first or second treatment. Let your treatment team know straight away if you feel hot or have any skin rashes, itching, dizziness, headaches, shivering, breathlessness, anxiety, flushing of the face, or a sudden need to pass urine
- Build up of fluid, leading to swelling in the arms and legs
- High blood pressure
- Blood clots – let your doctor or nurse know straight away if you have any redness, swelling or pain in your legs, or any chest pain or breathlessness
- Damage to heart muscle, which is usually temporary but for a small number of people may be permanent. Your doctor will check your heart before and after your treatment
- High bilirubin levels
- A high temperature (fever)
- A cough or breathlessness caused by changes to lung tissue
- Difficulty swallowing – let your nurse know if you have this
- Temporary changes in eyesight
You may have 1 or 2 or several 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 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)
- 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.
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 father a child while you are having treatment with this drug and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
You should not have immunisations with live vaccines while you are having treatment 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 treatment. 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.
This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information about these drugs 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. You will need to look at each drug individually.
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