This information is about a chemotherapy treatment called BEP, which is used to treat testicular cancer or a rare type of ovarian cancer.
The drugs that are used
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BEP is named after the initials of the chemotherapy drugs used, which are:
How treatment is given
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BEP chemotherapy can be given to you as a day patient or during a short stay in hospital. Before you start treatment you'll need to have a blood test, either on the same day or a few days beforehand. You'll also have tests to check how well your kidneys are working as the chemotherapy can affect them. These may include collecting your urine for 24 hours or having a specific blood test known as an EDTA test. You'll also be seen by a doctor, specialist nurse or pharmacist.
If the results of your tests are normal, the pharmacy will prepare your chemotherapy drugs. This may take a couple of hours.
When you begin your treatment, the nurse will insert a thin, flexible tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful, but it shouldn't take long. Some people have their chemotherapy given through a thin, plastic tube inserted under the skin and into a vein near their collarbone (central line) or passed through a vein in the crook of the arm (PICC line). Your doctor or nurse will explain more about this to you.
You'll be given an anti-sickness (anti-emetic) drug as tablets or by injection through the cannula, central line or PICC line, which is connected to a drip (infusion).
Bleomycin, etoposide and cisplatin are then given separately as drips (infusions) into your cannula or line. Each of the chemotherapy drugs are colourless fluids.
The bleomycin may sometimes be given as an injection into the muscle (intramuscularly). If you find this painful it can be given with a local anaesthetic.
Before and after treatment with cisplatin, you'll be given plenty of fluid through your cannula or line to keep your kidneys working normally.
How often treatment is given
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BEP chemotherapy can be given in different ways. Your doctor may use the word 'regimen' (eg the BEP regimen) when talking about your chemotherapy. This means the whole plan or schedule of the particular chemotherapy treatment you're having.
Here are descriptions of two different regimen for giving BEP. You can ask your doctor or nurse to tell you whether you're having one of these. If not, they can give you details of your regimen.
On the first day of your treatment (day one) you'll be given infusions of etoposide and cisplatin as described. The next day (day two) you'll have infusions of all three drugs, although the bleomycin is sometimes given as an intramuscular injection. On the third day (day three) you'll have just the etoposide.
If you are being treated as a day patient you can usually go home after each day's chemotherapy. If you have been an inpatient, you can usually go home after the chemotherapy on the third day.
Six days later (day nine) you'll come back to have bleomycin. After this you will have no treatment for a week. You'll have bleomycin again on day 16. You'll then have a rest period with no chemotherapy for a week.
This completes what is called a cycle of your treatment. Each cycle lasts for three weeks. Usually 2–4 cycles of BEP are given over a period of 2–3 months. This makes up a course of treatment.
On the first day of your treatment (day one) you will be given infusions of etoposide and cisplatin. The next day (day two) you'll have infusions of all three drugs, although the bleomycin is sometimes given as an intramuscular injection. On the third, fourth and fifth days, you will have etoposide and cisplatin again.
If you're being treated as a day patient you can usually go home after each day's chemotherapy. If you have been an inpatient, you can usually go home after the chemotherapy on the fifth day.
Four days later (day nine) you'll return to hospital to have bleomycin. You will then have a rest period with no chemotherapy until a week later (day 16), when you will have bleomycin again. After this you'll have another rest period without chemotherapy for five days.
This completes a cycle of your treatment. Each cycle lasts 21 days (three weeks). Usually 2–4 cycles of BEP are given over a period of 2–3 months. This makes up a course of treatment.
Each person’s reaction to chemotherapy is different. Some people have very few side effects while others may experience more. The side effects described here won't affect everyone having BEP chemotherapy.
We have outlined the most common side effects but haven't included those that are rare and unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
BEP can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you'll be more prone to infections. A low white blood cell count is called neutropenia.
Neutropenia begins seven days after treatment and your resistance to infection is usually at its lowest 10–14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38˚C (100.4˚F)
you suddenly feel unwell, even with a normal temperature.
You'll have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if your number of blood cells (blood count) is still low.
You may be given injections of G-CSF to help prevent the number of white blood cells getting too low. G-CSF is a type of protein that can stimulate the bone marrow to produce white blood cells. G-CSF is given as an injection under the skin (subcutaneously).
Bruising and bleeding
BEP can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You can have a platelet transfusion if your platelet count is low.
BEP can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Feeling sick (nausea) and being sick (vomiting)
Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea and vomiting. If the sickness isn't controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
This usually starts 3–4 weeks after starting treatment, although it may occur earlier. Hair usually falls out completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. This is temporary and your hair will start to grow again once the treatment has finished. Your hair may grow back straighter, curlier, finer or a slightly different colour than it was before. Your nurse can give you advice about coping with hair loss.
Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help reduce the risk of this happening. Some people may find sucking on ice soothing. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
You may notice that food tastes different. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
Bleomycin can cause a rash, which may be itchy. Your doctor can prescribe medicine to help with this. Your skin may darken due to overproduction of pigment. You may also notice long streaks on your skin, as if you have been scratched. Your skin will go back to normal a few months after treatment finishes.
Your kidneys may be affected
Cisplatin can affect your kidneys. This doesn't usually cause any symptoms and the effect is generally mild. Rarely, it may cause permanent damage to the kidneys unless the treatment is stopped.
Before each treatment, your kidneys will be checked by a blood test. You’ll be given fluid through a drip (infusion) before and after the treatment to keep your kidneys working normally. You may be asked to measure and record both what you drink and the amount of urine you pass. It’s important to tell your nurse or doctor if you pass less urine than usual.
If necessary, you may be given medicine to help you pass urine. You may be asked to drink extra fluid before and after treatment. It's important to do this so let your doctor know if this is a problem – for example, if you are feeling sick.
Changes in hearing
Cisplatin may cause ringing in the ears (tinnitus), and you may lose the ability to hear some high-pitched sounds. Hearing loss can be more severe with higher doses and longer courses of treatment. Very occasionally your sense of balance may be affected. Any hearing loss, and balance changes if they occur, may be permanent. However, tinnitus usually improves when treatment ends. Tell your doctor if you notice any loss of hearing or tinnitus.
The colour of your nails may change. They may become darker and white lines may appear on them. These usually grow out over several months once the treatment has finished.
Fevers and chills
This may happen several hours after bleomycin is given, but does not usually last long. Your doctor may give you a steroid drug (hydrocortisone) beforehand to reduce this effect.
Less common side effects
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Numbness or tingling in hands or feet
This is due to the effect of cisplatin on nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons or similar fiddly tasks.
Tell your doctor if you notice any numbness or tingling in your hands or feet. It's important to report your symptoms to your doctor as they may be controlled by slightly lowering the dose of the drug.
This side effect usually improves slowly a few months after the treatment has finished. Sometimes symptoms can persist; talk to your doctor if this happens.
Etoposide and cisplatin can cause diarrhoea. This can usually be easily controlled with medicine, but tell your doctor if it is severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Sometimes, areas that have previously been treated with radiotherapy may become red and sore. This is known as radiation recall. Let your doctor know if this happens. It is harmless and will go away after the chemotherapy has finished.
Changes to the lungs
Bleomycin can cause some changes to the lungs. This can happen during treatment or after it has finished. Your doctor can give you information about this potential side effect.
Tell your doctor if you smoke or if you notice any wheezing, coughing or breathlessness. You’ll probably have a chest x-ray before starting bleomycin treatment and you may have regular chest x-rays during your treatment.
Pain at injection site
Etoposide can cause pain along the vein that is used to give you your chemotherapy. If you feel any pain, tell your doctor or nurse straight away so they can check the infusion site. They may slow the infusion down to reduce pain.
Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, reddening of the face, dizziness, a headache, breathlessness, anxiety, and a feeling that you want to pass urine. You will be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse know about any side effects you have.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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Very rarely, etoposide may cause a second cancer, usually a type of acute leukaemia, to develop years later. Your nurse or doctor can discuss this with you.
Risk of developing a blood clot
Cancer can increase the risk of developing a blood clot (thrombosis), and chemotherapy may increase this risk further.
A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Some medicines, including those that you can buy in a shop or chemist, can be harmful to take when you are having chemotherapy. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your ability to get pregnant or father a child may be affected by having this treatment. It's important to discuss this with your doctor before starting treatment.
It's not advisable to become pregnant or to father a child while having BEP, as it may harm the developing baby. It's important to use effective contraception while taking these drugs, and for at least a few months afterwards. You can discuss this with your doctor or nurse.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
This section is based upon our BEP chemotherapy fact sheet, which has been compiled using information from a number of reliable sources including:
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
British National Formulary. 62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC). (acessed October 2011).
Perry MC. The Chemotherapy Source Book. 4th edition. 2007. Lippincott Williams and Wilkins.