This page tells you about the chemotherapy combination BEP and its possible side effects. There is information about
BEP is the name of a chemotherapy drug combination used to treat testicular cancer. BEP is made up of the drugs
Click on the links to find out the side effects of each individual drug.
There are a number of combinations of drugs for men with testicular cancer. BEP is one type of treatment and is the most commonly used. Your doctor will decide which combination is best to treat your type of testicular cancer and stage of testicular cancer. There is more information about these chemotherapy combinations in our section about treating testicular cancer.
You usually have chemotherapy as cycles of treatment. BEP can be given in different ways and these are described below.
Some people have etoposide and cisplatin on the first day of their treatment. The next day you have all 3 drugs and on the third day you have etoposide alone. A week later you have bleomycin and then again a week later. This is one cycle and lasts 3 weeks.
Some people have etoposide and cisplatin on the first day of treatment. The next day you have all 3 drugs. On the third, fourth and fifth day you have etoposide and cisplatin again. A week later you have bleomycin and then again a week later. This is one cycle and it also takes 3 weeks. Occasionally your doctor may decide not to give the 2nd or 3rd doses of bleomycin.
The number of cycles you have is usually between 2 and 4 and depends on
- Whether your cancer has spread
- How well your cancer responds to the drugs
For early testicular cancer, you may have only 2 cycles to help stop the cancer from coming back (recurrence). If your cancer has already spread, you may have 3 or 4 cycles. If you have an advanced testicular cancer, you may have more than 4 cycles.
You have the drug injections into a vein, or through a drip (intravenously). There are a few ways of doing this. You may have a thin, short tube (cannula) put into a vein in your arm on the day of each treatment. Or you may have chemotherapy through a plastic tube put into your chest, called a central line. a portacath or a PICC line. These tubes give the drugs into a major vein near the heart and stay in throughout your whole course of treatment.
The side effects of a combination of drugs are usually a mixture of the side effects of each drug. You may get one or two side effects or a few. The combination of drugs may increase or decrease your chance of getting each side effect. Or it may change the severity of the effects. We have listed the side effects associated with BEP below. You can use the links to find out how to cope with each effect. Where there is no link please see our cancer drugs side effects section or use the search box at the top of the page.
More than 10 in every 100 people have one or more of the side effects listed below.
A temporary drop in the number of blood cells made by the bone marrow. This can cause
- 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, sore throat, pain passing urine or feel cold and shivery
- 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).
Some of these side effects can be life threatening, particularly infections. You should contact your treatment centre if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.
Other common side effects include
- Fatigue (tiredness) during and after treatment – most people find their energy levels are back to normal from 6 months to a year after their treatment finishes
- Allergic reactions can sometimes happen when the chemotherapy is going into your bloodstream – tell your nurse if you have skin rashes and itching, feel hot, shivery, go red in the face, feel dizzy, have a headache, feel breathless or anxious, or have a sudden need to pass urine. You may have fever and chills the night after your treatment. Tell your doctor or nurse when you go for your next treatment
- Skin changes may occur causing reddening, darkening or thickening of the skin or you may have dry, peeling skin at the fingertips within 2 to 3 weeks of starting treatment
- Hair loss usually begins 4 to 5 weeks after you start treatment – it is temporary and your hair will grow back once treatment has finished.
- Loss of appetite or a metallic taste in your mouth.
- Feeling or being sick – you will usually have anti sickness injections and tablets. Sickness usually starts a few hours after each treatment and lasts for a few days. If it is not controlled, tell your doctor or nurse. You may be able to have other anti sickness medicines that work better for you
- A sore mouth or sores on the lips
- Dizziness or faintness from a drop in blood pressure if etoposide is given too quickly – call your nurse straight away to slow your drip down
- Ringing in the ears (tinnitus) – this nearly always gets better on its own but sometimes you may have permanent loss of high tone hearing
- Kidney damage – you will have blood tests before treatment to make sure your kidneys are able to cope with the treatment. Your nurse will ask you to drink plenty of water and give you fluids through your drip before and after your treatment to help flush out your kidneys
- Women may stop having periods (amenorrhoea) but this may only be temporary
- Loss of fertility – you may not be able to get pregnant or father a child after treatment with these drugs. Talk to your doctor about your fertility before starting treatment if having a baby is important to you
Between 1 and 10 in every 100 people have one or more of these.
- Inflammation of the lungs happens to about 1 in 10 patients treated with bleomycin but is not common in people under 70 – tell your doctor or nurse if you develop a dry cough or breathlessness, especially in cold weather. You will have lung tests before you start treatment and several times during the course. About 1 in 100 people treated with bleomycin has a long term problem with hardening of the lung tissue(fibrosis). It is important to tell your doctor or anaesthetist that you have had bleomycin if you need to have a general anaesthetic at a later date
- BEP can affect skin in areas treated with radiotherapy in the past, causing pain and a burning feeling and making the skin dry and flaky – this goes away on its own but keep affected areas out of the sun
- 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
- Diarrhoea – this is likely to be mild
There is a small risk of developing another cancer in the future after treatment with these drugs. If this is going to happen, it most often happens 5 to 8 years after treatment.
The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on
- How many times you've had the drug before
- Your general health
- The amount of the drug you have (the dose)
- Other drugs you are having
Talk to your doctor, pharmacist or nurse about all your side effects so that 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.
BEP may have a harmful effect on a developing baby. It is not advisable to become pregnant or father a child if you are having this treatment. Talk about contraception with your doctor or nurse before starting treatment.
Breastfeeding is not advisable during this treatment because the drug may come through in the breast milk.
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.
This information 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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