TIP is a chemotherapy treatment used to treat testicular cancer or germ cell tumours of the ovary.
This information should ideally be read with our general information about chemotherapy and your type of cancer.
TIP is named after the initials of the drugs used:
You have TIP in the chemotherapy day unit or during a stay in hospital. A chemotherapy nurse will give it to you. During treatment, you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.
You will also see a doctor or nurse before you have chemotherapy. They will ask you about how you have been. If your blood results are alright on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Before the chemotherapy, your nurse will give you anti-sickness drugs as an injection into a vein or as tablets. They will also give you medicines to prevent an allergic reaction. You may have steroids as an injection before your treatment. Or you may be given steroid tablets to take the day before your treatment. It’s important to take these exactly as the doctor or nurse has explained to you. You must tell your doctor or nurse if for any reason you haven't taken them.
You have these drugs and the chemotherapy through one of the following:
a short thin tube (cannula) that the nurse puts into a vein in your arm or hand.
a fine tube that goes under the skin of your chest and into a vein close by (central line).
a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
TIP chemotherapy is usually given over five days. Each drug is given as a drip (infusion). The nurses usually run the drip through a pump, which gives you the treatment over a set time.
On the first day of treatment, your nurse will give you paclitaxel over three hours. This is followed by cisplatin over four hours, and then ifosfamide over two hours. On days two, three, four and five, you will have cisplatin over four hours and ifosfamide over two hours, but you will not have paclitaxel. The timing of the drips can vary depending on where you’re being treated.
You will also be given a drug called mesna (Uromitexan ®). Mesna is given to help prevent irritation of the bladder wall which can be caused by ifosfamide. Symptoms of irritation can include pain and bleeding when passing urine. Mesna can be given as a drip or as an injection into the vein.
If you’re being treated as a day patient, you can usually go home after each day's chemotherapy. If you stay in hospital, you can usually go home after the chemotherapy on the fifth day.
When the chemotherapy is being given
Some people might have side effects while they are having the chemotherapy:
Paclitaxel may cause an allergic reaction while it’s being given. You will have medicines before your treatment to help prevent this. Your nurse will check you and if you have a reaction, they will treat it quickly. Signs of a reaction can include: a rash; feeling itchy, flushed or short of breath; swelling of your face or lips; feeling dizzy; having pain in your tummy, back or chest; or feeling unwell. Tell your nurse straight away if you have any of these symptoms.
The drug leaks outside the vein
If this happens when you’re having paclitaxel, it can damage the tissue around the vein. This is called extravasation. Tell the nurse straight away if you have any stinging, pain, redness or swelling around the vein. Extravasation is not common but it’s important that it’s dealt with quickly if it happens.
If you get any of these symptoms after you get home, contact the doctor or nurse straight away on the number they gave you.
Pain along the vein
If you have this, tell your nurse straight away. They will check your drip site and slow the drip to ease the pain.
Your course of treatment
You have chemotherapy as a course of several sessions (or cycles) of treatment over a few months. Each cycle of TIP takes 21 days (three weeks).
On the first day, you have paclitaxel, cisplatin and ifosfamide. On days 2–5, you have cisplatin and ifosfamide. After this, you’ll have a rest period with no chemotherapy for the next 16 days. This completes a cycle of treatment.
At the end of the 21 days, you start your second cycle of TIP. This is exactly the same as the first cycle. Usually, four cycles of TIP are given over 3–4 months. Your doctor or nurse will tell you the number of cycles you are likely to have.
Before you go home, the nurse or pharmacist will give you anti-sickness drugs to take. Take all your tablets exactly as they have explained to you.
Possible side effects of TIP
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We explain the most common side effects of TIP here. But we don’t include all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention, but you are very unlikely to get all of them. Always tell your doctor or nurse about the side effects you have. Your doctor can prescribe drugs to help control some of these.
It is very important to take the drugs exactly as your nurse or pharmacist has explained. This means they will be more likely to work better for you.
Your nurse will give you advice about managing your side effects. After your treatment is over, the side effects will start to improve.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice any time of day or night. Save these numbers in your phone or keep them somewhere safe.
Risk of infection
TIP can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. Your white cells start to reduce seven days after treatment and are usually at their lowest 10–14 days after. When the number of white blood cells is low, it’s called neutropenia.
Your nurse may give you injections of a drug called G-CSF under the skin. It encourages the bone marrow (where blood cells are made) to make more white blood cells.
Contact the hospital straight away on the contact number you’ve been given if:
your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
you suddenly feel unwell, even with a normal temperature
you have symptoms of an infection – this can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
The number of white blood cells usually increases steadily and returns to normal before your next treatment. You will have a blood test before having more chemotherapy. If your white blood cells are still low, your doctor may delay your treatment for a short time.
Bruising and bleeding
TIP can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin. Some people may need a drip to give them extra platelets.
Anaemia (low number of red blood cells)
TIP can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells (blood transfusion).
This may begin in the first few days after chemotherapy. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. They may also give you a steroid drug to help. Take the drugs exactly as your nurse or pharmacist explained to you. It’s easier to prevent sickness than to treat it after it has started.
If you still feel sick, or vomit twice or more in 24 hours, contact the hospital on the numbers they gave you as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you. Some people may need to go to hospital for a short time so the doctors and nurses can control their sickness.
Some anti-sickness drugs can make you constipated. Tell your doctor or nurse if this is a problem.
Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.
Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.
We have more information about mouth care during chemotherapy.
Your doctor can prescribe drugs to control diarrhoea. Let them know if it is severe or if it doesn’t get better. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
You may get a bitter or metallic taste in your mouth or find that food tastes different. This should go away when your treatment finishes. Try using herbs and spices (unless you have a sore mouth or ulcers) or strong-flavoured sauces to give your food more flavour. Sucking boiled sweets can sometimes help get rid of a bitter or metallic taste. Your nurse can give you more advice.
Feeling very tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after it’s finished. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
You usually lose all the hair on your head. Your eyelashes, eyebrows and other body hair may also thin or fall out. This usually starts after your first or second cycle of chemotherapy. It is almost always temporary and your hair will grow back after chemotherapy ends. It is important to cover your head to protect your scalp when you are out in the sun until your hair grows back. Your nurse can give you advice about coping with hair loss.
Changes in the way the kidneys work
Cisplatin can affect how your kidneys work. You will have blood tests before and during treatment to check this. You’ll have extra fluids through a drip before and after chemotherapy. This is to protect your kidneys. Your nurse will ask you to drink plenty of fluids. Tell them if there are any changes in how much urine you are producing.
Ifosfamide may irritate your bladder and cause discomfort when you pass urine. Drink plenty of fluids – at least two litres (three and a half pints) during the 24 hours following chemotherapy. It is also important to empty your bladder regularly and to try to pass urine as soon as you feel the need to go.
You will usually be given fluids through a drip (infusion) and the drug mesna as an infusion and/or tablets. This helps to prevent bladder irritation.
Contact the hospital straight away if you feel any discomfort or stinging when you pass urine, or if you notice any blood in it.
Numb or tingling hands or feet
These symptoms are caused by the effect of cisplatin and paclitaxel on nerves. It’s called peripheral neuropathy. You may also find it hard to fasten buttons or do other fiddly tasks.
Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes but in some people they may never go away. Talk to your doctor if you are worried about this.
Changes in hearing
Cisplatin can affect your hearing. You may have a hearing test before you start treatment. You may get ringing in your ears (tinnitus) and lose the ability to hear some high-pitched sounds. Tinnitus usually gets better after treatment ends. Some hearing changes can be permanent. Tell your doctor if you notice any changes in your hearing.
Chemotherapy may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. The chemotherapy can cause a rash, which may be itchy. Rarely, your skin may darken. It will return to its normal colour after you finish treatment. If you’ve had radiotherapy (either recently or in the past), the area that was treated may become red or sore.
Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
Your nails may become brittle and break easily. They may get darker or discoloured. These changes usually grow out over several months after treatment finishes. Rarely, nails may come off, but they will grow back after treatment. Wearing gloves when washing dishes or using detergents will help protect your nails during treatment.
If you get pain, redness or swelling around your nails, let your nurse or doctor know.
Muscle and/or joint pain
You may get pain in your joints or muscles for a few days after chemotherapy. Tell your doctor if this happens so they can prescribe painkillers. Let them know if the pain does not get better. Try to get plenty of rest. Taking regular warm baths may help.
Less common side effects of TIP
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Low blood pressure
Paclitaxel may cause this. Tell your doctor or nurse if you have ever had any problems with your blood pressure. Your nurse will check it regularly during treatment. Let them know if you feel dizzy.
Changes in the way the liver works
Paclitaxel may affect how your liver works. This is usually mild and goes back to normal after treatment. You will have blood tests to check how well your liver is working.
Changes to your heartbeat
Paclitaxel may cause changes to your heartbeat. This doesn’t usually cause serious problems and goes back to normal after treatment finishes. Let your doctor know if you notice your heartbeat is irregular or slow.
Effects on the nervous system
Ifosfamide can affect the nervous system. You may feel very drowsy or confused, or you may have hallucinations. You may feel dizzy or unsteady. Rarely, this treatment can cause seizures (fits). Tell your doctor or nurse straight away if you have any of these symptoms. They may make some changes to your treatment if they become a problem for you.
It’s important not to drive or operate machinery if you have these side effects.
It’s important to tell your doctor or nurse straight away if you feel ill or have severe side effects. This includes any we don’t mention here.
Other information about TIP
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Blood clot risk
Cancer increases the chance of a blood clot (thrombosis) and chemotherapy can add to this. A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain. Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Some medicines can interact with chemotherapy or be harmful when you are having chemotherapy. This includes medicines you can buy in a shop or chemist. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Chemotherapy may affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor or nurse before treatment starts.
Your doctor will advise you not to become pregnant or to father a child during treatment. This is because the drugs may harm a developing baby. It’s important to use effective contraception during and for a few months after chemotherapy. You can talk to your doctor or nurse about this
If you have sex within the first couple of days of having chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluid.
Changes to your periods
Chemotherapy can sometimes stop the ovaries working. You may not get a period every month and they may eventually stop. In some women, this is temporary, but for others it is permanent and they start the menopause.
Women are advised not to breastfeed during treatment and for a few months after. This is to make sure there is no chemotherapy in their breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Give them contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
This section has been compiled using a number of reliable sources, including:
British National Formulary. 65th edition. 2013. British Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC). medicines.org.uk (accessed September 2013).
Micromedex ® 2.0 micromedexsolutions.com (accessed September 2013)
With thanks to Bruce Burnett, Teacher Practitioner in Clinical Pharmacy Practice, who reviewed this edition.
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