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Bleomycin, etoposide and platinum (BEP)

BEP is commonly used as a treatment for men with testicular cancer. It's a combination of 3 chemotherapy drugs: 

  • bleomycin
  • etoposide
  • platinum (cisplatin)

Doctors may also use BEP to treat a rare type of ovarian cancer called teratoma of the ovary. 

How it works

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

How you have BEP

You have these drugs into your bloodstream, usually through a long line: a central line, a PICC line or a portacath.

These are long, plastic tubes that give the drugs into a large vein in your chest. The tube stays in place throughout the course of your treatment.

When you have it

You usually have BEP as a course of several cycles of treatment. A cycle of treatment is the time between 1 round of treatment and the start of another. Usually each treatment cycle lasts 3 weeks (21 days). The first day of treatment cycle is called day 1. 

You might have between 2 and 4 treatment cycles. The number of cycles you have depends on:

  • whether your cancer has spread
  • how well your cancer responds to BEP

If you have an early testicular cancer, you may have 2 treatment cycles of BEP. This is to stop the cancer from coming back (recurrence). 

If your testicular cancer has spread to another part of your body, you may have 3 or more treatment cycles. 

You can have BEP in different ways. A common way of having BEP is:

Day 1
  • etoposide as an injection into your bloodstream (intravenously)
  • cisplatin as an injection into your bloodstream over 1 to 4 hours
  • bleomycin as an injection into your bloodstream (you might have bleomycin on day 2 instead of day 1)
Day 2
  • etoposide as an injection into your bloodstream
  • cisplatin as an injection into your bloodstream
Day 3
  • etoposide as an injection into your bloodstream
Day 8
  • bleomycin as an injection into your bloodstream
Day 15
  • bleomycin as an injection into your bloodstream

Another way of having BEP chemotherapy is:

Day 1
  • etoposide as an injection into your bloodstream
  • cisplatin as an injection into your bloodstream
  • bleomycin as an injection into your bloodstream (you might have bleomycin on day 2 instead of day 1)
Day 2
  • cisplatin as an injection into your bloodstream
  • etoposide as an injection into your bloodstream
Day 3, 4 and 5
  • etoposide as an injection into your bloodstream
  • cisplatin as an injection into your bloodstream
Day 8
  • bleomycin as an injection into your bloodstream
Day 15
  • bleomycin as an injection into your bloodstream

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.

Side effects

We haven't listed all the side effects. It's very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely 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. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

Common side effects

Each of these effects happens in more than 1 in 10 people (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. 

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 petechia).

Breathlessness and tiredness

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques, can all 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 treating it once it has started.

Loss of appetite and weight loss

You might not feel like eating and may lose weight. It is important to eat as much as you can. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss. 

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg 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. 

Diarrhoea or constipation

Tell your doctor or nurse if you have diarrhoea or constipation. They can give you medicine to help. 

Lung problems

You might develop a cough or breathing problems. This could be due to infection, such as pneumonia or inflammation of the lungs (pneumonitis). Let your doctor or nurse know straight away if you suddenly become breathless or develop a cough.

Skin problems

Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. Your nurse will tell you what products you can use on your skin to help.

The colour of your skin might also get darker. And your skin might also thicken. 

Tummy (abdominal) pain

You might get pain in the tummy (abdomen). Contact your healthcare advice line or tell a member of your healthcare team. 

Changes to how 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.

You might also have yellowing of the skin and whites of the eyes. 

Feeling weak and generally unwell

This is usually mild. You can do things to help yourself, including some gentle exercise. It’s important not to push yourself too hard and eat a well balanced diet.

Talk to your doctor or nurse if this effect is stopping you from doing your usual daily activities.

Changes to the amount of minerals in your blood

You may have changes in levels of minerals and salts in your blood, including low levels of sodium or high levels of uric acid (causing gout). You have regular blood tests during treatment to check this.

Sore mouth

It may be painful to swallow drinks or food. Painkillers and mouth washes can help to reduce the soreness and keep your mouth healthy. 

Inflammation of the lining of your throat, gut and bowels

The lining of your throat, gut and bowels might become sore and swollen. Contact your healthcare advice line or tell a member of your healthcare team if this happens. 

Inflamed sore fingertips

Your fingertips might become swollen and tender. Contact your healthcare advice line or tell a member of your healthcare team if this happens.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (1 to 10%). You might have one or more of them. They include:

  • severe breathing problems that start quickly and are life threatening; signs are shortness of breath, rapid shallow breathing, tiredness, drowsiness or confusion, feeling faint. Dial 999 straight away if you have these symptoms
  • blood clots that are life threatening; signs are pain, swelling and redness where the clot is. Feeling breathless can be a sign of a blood clot on the lung. Contact your advice line or doctor straight away if you have any of these symptoms
  • an allergic reaction this mostly happens with the 1st or 2nd dose can be during or up to a few hours after, signs include wheezing, difficulty breathing, swelling and itching; if you have any of these symptoms contact your doctor straight away
  • developing a blood cancer (leukaemia)
  • heart problems such as your heart beating fast or slow and heart attack
  • high blood pressure - you might have low blood pressure during your etoposide treatment if it is given too quickly
  • redness, swelling and pain around the injection site
  • headaches and or dizziness

Rare side effects

These side effects happen in fewer than 1 in 100 people (1%). You might have one or more of them. They include:

  • pain in your muscles, joints and where the cancer is
  • confusion
  • low blood pressure
  • changes to the shapes and colour of your nails
  • blistering
  • passing urine often or not being able to pass urine
  • discomfort when passing urine
  • an increase in the level of magnesium in the blood
  • hearing problems

Coping with side effects

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

What else do I need to know?

Other medicines, food and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

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 may be able to store sperm before starting treatment. Women may be able to store eggs or ovarian tissue but this is rare.

Contraception and pregnancy

This treatment 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 at least 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

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

Treatment for other conditions 

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

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 the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)
  • 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 oral polio or the typhoid vaccine.

This also includes the rotavirus vaccine given to babies. The virus is in the baby’s poo for up to 2 weeks and could make you ill. So avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.

You should also avoid close contact with children who have had the flu vaccine nasal spray. You should do so for 2 weeks following their vaccination if you have a severely weakened immune system.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help