This information is about a chemotherapy treatment called TIP, which is sometimes used to treat testicular cancer or germ cell tumours of the ovary.
You'll need to see your hospital doctor regularly while you have this treatment so they can monitor the effects of the chemotherapy.
The drugs that are used
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TIP is named after the initials of the chemotherapy drugs used. These are:
How treatment is given
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TIP chemotherapy can be given to you as a day patient or during a stay in hospital. Before you start treatment you'll need to have a blood test, either on the same day or a day or two beforehand. You'll be seen by a doctor, specialist nurse or pharmacist. You will 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.
If the results of your tests are normal, the pharmacy will prepare your chemotherapy drugs. This may take a couple of hours.
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 the collarbone (central line) or passed through a vein in the crook of their arm (a PICC line). Your doctor or nurse will explain more about this to you.
Before the chemotherapy, you'll be given anti-sickness (anti‑emetic) drugs, usually by injection through the cannula, your central line or PICC line. Some anti-sickness drugs can be given as tablets.
You will also be given medicines to prevent the allergic reaction that some people have when given paclitaxel. This anti-allergy medicine is often given by injection, but part of it is sometimes given as steroid tablets that you take at home before coming to the hospital. It's very important to take the tablets, and you must tell your doctor or nurse if for any reason you haven't taken them
The chemotherapy drugs are then given separately. Paclitaxel, ifosfamide and cisplatin are all colourless fluids given as separate drips (infusions) into your cannula or line.
Before and after treatment with cisplatin, you will 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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Your doctor may use the word 'regimen' (eg the TIP regimen) when talking about your chemotherapy. This means the whole plan or schedule of the treatment that you are having. TIP chemotherapy is usually given over five days.
On the first day of your treatment, you'll be given all three drugs as described above.
First you will be given paclitaxel over three hours, followed by cisplatin over four hours, then ifosfamide over two hours. However, these times can vary depending on the hospital where you’re being treated.
Ifosfamide can irritate the bladder lining and cause bleeding. To counteract this you'll be given a drug called mesna (Uromitexan®). Mesna can be given as an infusion connected to your cannula or line, or as an injection into the line. It's usually given before, during and after the ifosfamide is given.
On days 2-5, you’ll be given cisplatin and ifosfamide in the same way as on the first day of your treatment, but you won’t be given paclitaxel. After this, you’ll have a rest period with no chemotherapy for the next 16 days. This completes what's called a cycle of treatment. Each cycle lasts 21 days (three weeks).
Usually four cycles of TIP are given over a period of 3-4 months. This makes up a course of treatment.
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.
You’ll be given anti-sickness tablets to take with you. It’s important to take these as directed, even if you aren't feeling sick. This is because some anti-sickness drugs are much better at preventing sickness than stopping it once it begins. You may also be given mesna to take as tablets to protect your bladder and kidneys from the effects of ifosfamide. Your chemotherapy nurse will tell you how to take these.
Each person’s reaction to chemotherapy is different. Some people have very few side effects while others experience more. The side effects described here won't affect everyone having TIP chemotherapy. Side effects are usually temporary and go away when your chemotherapy is over.
We have outlined the most common side effects but haven't included those that are rare and therefore 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
TIP 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 will be more prone to infections. A low white blood cell count is called neutropenia. This 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 (100.4F)
you suddenly feel unwell, even with a normal temperature.
You will 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
TIP 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.
TIP 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)
This may begin 2-3 hours after the treatment is given and can last for up to two weeks. Your doctor can prescribe 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 taking some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Hair loss 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 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 find our section on mouth care during chemotherapy helpful.
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.
Your kidneys may be affected
This doesn't usually cause any symptoms, and the effect is generally mild. Rarely, treatment 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 to 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.
TIP 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.
Numbness or tingling in hands or feet
This is due to the effect of cisplatin and paclitaxel 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.
Ifosfamide can cause a rash, which may be itchy. Your doctor can prescribe medicine to help with this. Your skin may darken because of excess production of pigment. It usually returns to normal a few months after the treatment has finished.
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. Some people have pain in the nail bed at the base of the nail, but this is rare.
Aching or pain in joints and muscles
You may have these symptoms a few days after treatment with paclitaxel. This doesn't usually last long and your doctor can prescribe mild painkillers to help.
Some people have an allergic reaction to paclitaxel. Signs of this can include skin rashes and itching, a high temperature, shivering, dizziness, a headache and breathlessness.
Usually you will be given steroid tablets to take at home the day before treatment to reduce the chance of this happening. It’s important to take the steroid tablets as you have been directed. Instead of steroid tablets, you may be given a steroid by injection into a vein (intravenously) 30-60 minutes before the paclitaxel. Other drugs such as antihistamines may also be injected into a vein before your treatment to prevent an allergic reaction.
You will be closely monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse if you have any of these symptoms. If you do have a reaction, it can be treated quickly.
Ifosfamide may irritate the bladder. It’s important to drink as much fluid as you can (at least two litres a day) during the treatment. You’ll usually be given fluids through a drip (infusion), along with a drug called mesna (Uromitexan®) to help prevent bladder irritation. Your urine will be measured and tested for blood. If there’s any blood in your urine you’ll be given more mesna.
Always let your doctor or nurse know about any side effects you have. There are usually ways in which they can be controlled or improved.
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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 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 fertility with your doctor before starting treatment
It's not advisable to become pregnant or to father a child while having TIP, 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 TIP chemotherapy fact sheet which has been compiled using information from a number of reliable sources, including:
British National Formulary. 62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC). www.medicines.org.uk (accessed October 2011).
Guidelines on Testicular Cancer. 2008. European Association of Urology.
Perry MC. The Chemotherapy Source Book. 4th edition. 2008. Lippincott Williams and Wilkins.
Sweetman, et al. The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.