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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 and germ cell cancers. Germ cell cancers most often occur in the ovary or testicle.

EP is made up of the drugs

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

How you have treatment

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 just before your course of treatment starts and it stays in place as long as you need it.

Etoposide also comes as capsules that you swallow. You should swallow these whole with plenty of fluid. 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. You may have up to 6 cycles. Each cycle of treatment lasts 3 weeks.

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

  • On the first day of treatment you have etoposide and cisplatin as a drip for a couple of hours
  • On the second and third days you have etoposide as a drip or as capsules that you can take at home

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

  • On the first day of treatment you have etoposide and cisplatin as a drip for a couple of hours
  • On the second and third days you have etoposide as a drip. In some hospitals you may also have a further 2 days of etoposide as a drip.

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.

After this you have no treatment for just over 2 weeks. Then you start the next 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 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.

 

Common side effects

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, causing

  • 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 doctor or specialist nurse 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

  • Hair loss happens to about 7 out of 10 people (70%) but is temporary
  • Tiredness 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, but 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) which 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 immediately
  • A sore mouth
  • Drop in blood pressure – tell your nurse if you feel dizzy or faint while having the etoposide drip, as 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
 

Occasional side effects

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

  • Women may stop having periods (amenorrhoea) – this may only be temporary
  • Loss of fertility – we don’t know exactly how these drugs affect fertility so do talk with your doctor before starting treatment if you plan to have a baby in the future
  • 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 hot or shivery, go red in the face, feel dizzy, have a headache, feel breathless, feel anxious, or suddenly need to pass urine
 

Important points to remember

Not everyone will get these side effects. You may have 1 or 2 or several. 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)
  • The way you take the drug (capsules or drip)
  • Other drugs you are having

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 other over the counter remedies – some drugs can react together.

EP drugs may have a harmful effect on a developing baby. You should not become pregnant or father a child while having this treatment. If there is any possibility that you or your partner could become pregnant, discuss contraception with your doctor or nurse before having the treatment.

Breastfeeding is not advisable 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: 15 May 2013