BEP

BEP is a combination treatment used to treat testicular cancer and a rare type of ovarian cancer.

It is best to read this information with our general information about chemotherapy and the type of cancer you have.

BEP is usually given into a vein and as an injection into a muscle. You usually have it as an outpatient or during a hospital stay. Your cancer doctor, nurse or pharmacist will tell you how often you will have it.

BEP can cause side effects. Some of the side effects can be serious, so it is important to read the detailed information below.

Your healthcare team can give you advice on how to manage any side effects. Tell your doctor or nurse straight away if you:

  • have a temperature
  • feel unwell
  • have severe side effects, including any we do not mention here.

Rarely, side effects may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

If you need medical attention for any reason other than cancer, always tell the healthcare staff that you are having this treatment.

What is BEP?

BEP is used to treat testicular cancer and a rare type of ovarian cancer. It is best to read this information with our general information about chemotherapy and the type of cancer you have.

Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.

BEP comes from the initials of the drugs used:


How BEP is given

You will be given BEP 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, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist 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 your blood cells are at a safe level to have chemotherapy.

You will see a doctor or nurse before you have chemotherapy. They will ask you how you have been feeling. If your blood results are okay, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.

Your nurse usually gives you anti-sickness (anti-emetic) drugs before the chemotherapy. You will be given extra fluids through a drip before and after cisplatin chemotherapy. This is to protect your kidneys and maintain the balance of salts in your blood. You may also be given a drug called mannitol. Mannitol increases the amount of urine your kidneys make.

The chemotherapy drugs can be given through:

  • a short thin tube the nurse puts into a vein in your arm or hand (cannula)
  • 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).

Your nurse will give you the chemotherapy drugs separately as drips (infusions) into your cannula or line. The drips are usually run through a pump, which gives you the chemotherapy over a set time.

Bleomycin can sometimes be given as an injection into a muscle (IM). Your nurse will tell you how you will be given the bleomycin.

Your course of BEP

You usually have a course of several cycles of treatment over a few months. Your nurse or doctor will discuss your treatment plan with you.

BEP can be given in different ways. We describe two ways you might have it. Your doctor or nurse will be able to give you details of your treatment course.

Three-day BEP:

On day one the nurse will give you:

  • cisplatin as an infusion
  • etoposide as an infusion.

On day two the nurse will give you:

  • cisplatin as an infusion
  • etoposide as an infusion
  • bleomycin as an infusion or as an injection into a muscle.

On day three the nurse will give you:

  • etoposide as an infusion.

Sometimes, bleomycin is given on day one instead of day two.

If you are having BEP as an outpatient, you can usually go home after each day of chemotherapy. If you are having BEP as an inpatient, you can usually go home after the chemotherapy on the third day.

Around one week after you started the cycle (day eight or nine), you have bleomycin again. You then have a rest week with no chemotherapy. The bleomycin is given again on day fifteen or sixteen. There is another rest week with no chemotherapy. Your nurse will explain which days you will have the treatment on.

This completes what is called a cycle of your chemotherapy treatment. Each cycle takes 21 days.

At the end of the 21 days, you start your second cycle of BEP. This is the same as the first cycle.

Your doctor or nurse will tell you the number of cycles you are likely to have.

Five-day BEP:

On day one the nurse will give you:

  • cisplatin as an infusion
  • etoposide as an infusion.

On day two the nurse will give you:

  • cisplatin as an infusion
  • etoposide as an infusion
  • bleomycin as an infusion or as an injection into a muscle.

On day three, four and five the nurse will give you:

  • cisplatin as an infusion
  • etoposide as an infusion

Sometimes, bleomycin is given on day one instead of day two.

If you are having BEP as an outpatient, you can usually go home after each day of chemotherapy. If you are having BEP as an inpatient, you can usually go home after the chemotherapy on the fifth day.

Around one week after you started the cycle (day eight or nine), you have bleomycin again. You then have a rest week with no chemotherapy. The bleomycin is given again on day fifteen or sixteen. You then have another rest week with no chemotherapy. Your nurse will explain which days you will have the treatment on.

This completes what is called a cycle of your chemotherapy treatment. Each cycle takes 21 days.

At the end of the 21 days, you start your second cycle of BEP. This is the same as the first cycle.

Your doctor or nurse will tell you the number of cycles you are likely to have.


About side effects

We explain the most common side effects of this treatment here. We also include some less common side effects. You may get some of the side effects we mention, but you are unlikely to get all of them.

You may also have some side effects that we haven’t listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.

Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.

Serious and life-threatening side effects

Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

More information

We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) to download a Patient Information Leaflet (PIL) for these drugs. The leaflet lists all known side effects.


Side effects while treatment is being given

Some people may have side effects while they are being given the chemotherapy or shortly after they have it:

Allergic reaction

Some people have an allergic reaction while having this treatment. Signs of a reaction can include:

  • feeling hot or flushed 
  • a skin rash
  • itching
  • shivering
  • feeling dizzy
  • a headache
  • feeling breathless 
  • swelling of your face or mouth
  • pain in your back, tummy or chest.

Your nurse will check you for signs of a reaction during your treatment. If you feel unwell or have any of these signs, tell them straight away. If you do have a reaction, it can be treated quickly.

Sometimes a reaction can happen a few hours after treatment. If you get any signs or feel unwell after you get home, contact the hospital straight away.

The drug leaks outside the vein

If this happens it can damage the tissue around the vein. This is called extravasation. Extravasation is not common but if it happens it is important that it’s dealt with quickly. Tell your nurse straight away if you have any stinging, pain, redness or swelling around the vein.

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

You may get pain at the place where the injection is given or along the vein. If you feel pain, tell your nurse or doctor straight away so that they can check the site. They may give the drug more slowly or flush it through with more fluid to reduce pain.

Problems at the injection site

Bleomycin can be given as an injection into a muscle. Sometimes it causes redness and swelling where it is given (injection site). This can be uncomfortable. To reduce the irritation, your nurse will change the injection site each time you have an injection. They can also give you advice on how to relieve any discomfort.

Flu-like symptoms

Bleomycin may cause flu-like symptoms, such as:

  • feeling hot or cold and/or shivery
  • a headache
  • aching.

You may have these symptoms while the drug is being given or several hours after. Your nurse will tell you if this is likely to happen. They may advise you to take paracetamol. Drinking plenty of fluid will also help. Your nurse may give you a drug before your chemotherapy to reduce the risk of these symptoms happening.

If the symptoms are severe or don’t improve after 24 hours, contact the hospital.


Common side effects

Risk of infection

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.

If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have if:

  • your temperature goes over 37.5°C (99.5F)
  • you suddenly feel unwell, even with a normal temperature
  • you have symptoms of an infection.

Symptoms of an infection include:

  • feeling shivery
  • a sore throat
  • a cough
  • diarrhoea
  • needing to pass urine often.

It is important to follow any specific advice your cancer treatment team gives you.

The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more chemotherapy. If your white blood cell count is low, your doctor may delay your treatment for a short time.

G-CSF (granulocyte-colony stimulating factor) is a type of drug called a growth factor. It encourages the body to make more white blood cells.

Your doctor may give you G-CSF:

  • if the number of white blood cells is very low
  • to stop the number of white blood cells getting low.

You have it as a small injection under the skin.

Bruising and bleeding

Chemotherapy can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor or nurse if you have any bruising or bleeding that you can’t explain. This includes:

  • nosebleeds
  • bleeding gums
  • tiny red or purple spots on the skin that may look like a rash.

Some people may need a drip to give them extra platelets. This is called a platelet transfusion.

Anaemia (low number of red blood cells)

Chemotherapy 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. This is called a blood transfusion.

Feeling sick

You may feel sick in the first few days after chemotherapy. Your doctor will give you anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.

If you feel sick, take small sips of fluids and eat small amounts often. If you continue to feel sick, or if you vomit more than once in 24 hours, contact the hospital as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you.

Feeling tired

Feeling tired is a common side effect. It is often worse towards the end of treatment and for some weeks after it has finished. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy. If you feel sleepy, do not drive or operate machinery.

Hair loss

Your hair will get thinner or you may lose all the hair from your head. You may also lose your eyelashes, eyebrows or other body hair. Hair loss usually starts after your first or second treatment.

Your nurse can talk to you about ways to cope with hair loss. There are ways to cover up hair loss if you want to. It is important to cover your head to protect your scalp when you are out in the sun.

Hair loss is almost always temporary and your hair will usually grow back after treatment ends.

Sore mouth

You may get a sore mouth or mouth ulcers. This can make you more likely to get a mouth infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

If your mouth is sore:

  • tell your nurse or doctor – they can give you a mouthwash or medicines to help
  • try to drink plenty of fluids
  • avoid alcohol, tobacco, and foods that irritate your mouth.

Changes to your taste

You may get a bitter or metal taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste bad or have no taste. Try different foods to find out what tastes best to you. Taste changes usually get better after treatment finishes. Your nurse can give you more advice.

Skin changes

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.

Your skin may darken during treatment. Occasionally, bleomycin causes scratch-like streaks to appear on of the skin. If you have had radiotherapy (either recently or in the past), the area that was treated may become red or sore.

During treatment and for several months afterwards, you'll be more sensitive to the sun and your skin may burn more easily than usual. You can still go out in the sun, but you need to use a sun cream with a sun protection factor (SPF) of at least 30. You should also cover up with clothing and a hat.

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.

Effects on the kidneys

Cisplatin can affect how your kidneys work. You will have blood tests before and during treatment to check this. 

Before and after each treatment, your nurses will give you extra fluids through a drip. This is to protect your kidneys. It’s also important to drink at least two litres (three and a half pints) of fluids each day.  

If you pass less urine than usual, tell your nurse.

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. This is called tinnitus. You may also 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.

Nail changes

Your nails may grow more slowly or break more easily. You may notice white lines across your nails, or other changes to their shape or colour. Once the treatment has ended, any changes usually take a few months to grow out.

There are things you can do to look after your nails:

  • Keep your nails and hands moisturised.
  • Wear gloves to protect your nails when you are doing things in the house or garden.
  • Don’t use false nails during this treatment. It is fine to wear nail varnish.
  • If your toenails are affected, wear well-fitted shoes to cushion them.

Headaches

This treatment may cause headaches. If this happens, tell your doctor or nurse. They can give you painkillers.

Effects on the liver

This treatment can affect how your liver works. This usually goes back to normal after treatment. You will have blood tests to check how well your liver is working during your treatment.

Abdominal pain

Let your doctor know if you develop any pain in your tummy (abdomen). It can usually be controlled with mild painkillers.


Less common side effects

Effects on the heart

This treatment can affect the way the heart works. You may have tests to see how well your heart is working. These may be done before, during, and sometimes after treatment. If the treatment is causing heart problems, your doctor can change the type of treatment you are having. 

Contact a doctor straight away if you:

  • have pain or tightness in your chest 
  • feel breathless or dizzy
  • feel your heart is beating too fast or too slowly.

Other conditions can cause these symptoms, but it is important to get them checked by a doctor.

Numb or tingling hands or feet (peripheral neuropathy)

This treatment affects the nerves, which can cause numb, tingling or painful hands or feet. You may 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 or delay treatment for a short time. The symptoms usually improve slowly after treatment finishes, but for some people they may never go away. Talk to your doctor if you are worried about this.

Diarrhoea

If you have diarrhoea, contact the hospital for advice. Try to drink at least two litres (three and a half pints) of fluids every day. It can help to avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.

Constipation

This treatment can cause constipation. Here are some tips that may help:

  • Drink at least two litres (three and a half pints) of fluids each day.
  • Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
  • Do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.

Effects on the lungs

You may have tests to check your lungs before and during treatment. Tell your doctor if you develop:

  • a cough
  • wheezing
  • a fever (high temperature)
  • breathlessness

You should also tell them if any existing breathing problems get worse.

After treatment with bleomycin, breathing higher doses of oxygen for several hours can cause lung problems. If you need to have a general anaesthetic or oxygen therapy in the future, always tell the doctor that you have had bleomycin.

Scuba diving is not recommended after treatment with bleomycin.

Second cancer

BEP can increase the risk of developing a second cancer years later. This is rare. The benefits of treatment usually far outweigh this risk. Your doctor can talk to you about this.


Other information

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:

  • pain, redness or swelling in a leg or arm
  • breathlessness
  • chest pain. 

If you have any of these symptoms, contact a doctor straight away. 

A blood clot is serious, but can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.

Other medicines

Some medicines can affect chemotherapy or be harmful when you are having it. This includes medicines you can buy in a shop or chemist. Tell your cancer doctor about any drugs you are taking, including vitamins, herbal drugs and complementary therapies.

Contraception

Your doctor will advise you not to get pregnant or father a child while having this treatment. The drugs may harm the developing baby. It is important to use effective contraception.

Breastfeeding

Women are advised not to breastfeed while having this treatment and for some time afterwards. This is because the drugs could be passed to the baby through breast milk.

Fertility

Some cancer drugs can affect whether you can get pregnant or father a child. If you are worried about this, it is important to talk with your doctor before you start treatment.

Sex

If you have sex in the first few days after chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluids.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.

If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.