TIP

TIP is the name of a combination of chemotherapy drugs and is made up of paclitaxel, ifosfamide and cisplatin. It is a treatment for testicular cancer.

What is TIP?

TIP is a combination of chemotherapy drugs that includes:

• paclitaxel (Taxol)
• ifosfamide
• cisplatin (platinum)

It is a treatment for testicular cancer that has spread or come back.

How does TIP work?

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

How do you have TIP?

You have all drugs as a drip into your bloodstream (intravenously).

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

How often do you have TIP?

You usually have TIP chemotherapy as cycles of treatment. This means that you have the drug and then a rest to allow your body to recover. Each cycle of treatment lasts 21 days (3 weeks). You have 4 to 6 cycles.

You usually have each cycle of treatment in the following way:

You then start the next treatment cycle. You might need to stay in hospital while you are having treatment with TIP.

Mesna

You also have the drug mesna, which is not chemotherapy. Mesna helps to stop the ifosfamide from irritating your bladder and making the lining bleed. You also need to have plenty of fluids to help keep your kidneys working normally.

GCSF injections

You might have growth factor injections to help your blood cell counts recover after treatment. This usually starts about a week after treatment, and you have a daily injection for 7 days.

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.

What are the side effects of TIP?

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.

When to contact your team

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

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of getting an infection

Increased risk of getting an infection

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.

Breathlessness

You might be

breathless and look pale

Bruising, bleeding gums or nosebleeds

This is due to a

drop in the number of platelets in your blood

Feeling or being sick

Feeling or being sick

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 treat it once it has started.

Irritation of the bladder

This treatment can cause irritation of the bladder. Symptoms include:

• pain or burning when passing urine
• urgency to go to the toilet
• needing to pass urine more often
• pink or red colour urine due to blood, you might also pass blood clots

You have another drug called mesna to help protect your bladder.

Talk to your team if you notice blood in your urine

Kidney damage

To help prevent

kidney damage

Hair thinning

Your hair may thin but you’re unlikely to lose all your hair. This usually starts after your first or second cycle of treatment. It is almost always temporary and your hair will grow back when you finish your treatment.

Diarrhoea

Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days.

Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.

Mouth sores and ulcers

Mouth sores and ulcers

Numbness or tingling in fingers or toes

Numbness or tingling in fingers or toes

Pain in your muscles and joints

This might start a couple of days after treatment and last for about 5 days. Speak to your doctor or nurse about what painkillers you can take to help with this.

Allergic reaction

You might have a mild allergic reaction during or shortly after your treatment. This could be a rash, itching or a red face.

Less commonly you might have breathing difficulties, fever and chills. Let your team know straight away if you are feeling unwell. They will slow down or stop your drip for a while.

Low blood pressure

Tell your doctor or nurse if you feel light headed or dizzy. You have your blood pressure checked regularly.

Rarely you might have high blood pressure.

Headaches

Tell your doctor or nurse if you keep getting headaches. They can give you painkillers to help.

Low levels of minerals in the blood

You might have low levels of sodium or magnesium. You will have regular blood tests to check for this.

High temperature (fever)

If you get a high temperature, let your health care team know straight away. Ask them if you can take paracetamol to help lower your temperature.

Occasional side effects

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

• redness, swelling or leaking at the drip site
• liver changes that are mild and unlikely to cause symptoms. Rarely, you might have yellowing of the skin or whites of the eyes (jaundice).
• loss of appetite
• skin or nail problems such as dry or itchy skin, a rash, or irritation of the skin. Less commonly you might have severe peeling or blistering of the skin.
• blood clots that can be life threatening; signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these
• confusion, sleepiness or extreme lack of energy (lethargy)
• change in heart rate or rhythm

Rare side effects

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

• swelling of legs and arms due to fluid build up
• tiredness and weakness (fatigue) after treatment
• constipation
• heart problems such as enlarged heart, changes to the heart muscle, fluttering, heart failure, or a heart attack
• lung problems causing breathlessness and a cough. Rarely, this can be life threatening.
• hearing problems - you might have some hearing loss, especially with high pitched sounds. You might also have some ringing in your ears (tinnitus). Tell your doctor or nurse if you notice any changes.
• tummy (abdominal) pain
• changes to the lung tissue that can cause cough and breathlessness. Rarely this can be life threatening
• a second cancer such as acute leukaemia some time after treatment
• Stevens-Johnson syndrome - a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This could be life threatening.
• fits (seizures)
• posterior reversible encephalopathy syndrome (PRES) - a rare disorder of the nerves causing headache, fits, confusion and changes in vision - contact your health team straight away. This condition is reversible

Other side effects

There isn't enough information to work out how often these side effects might happen. You might have one or more of them. They include:

• soreness, redness, and peeling on palms of hands or soles of feet
• a blood clotting disorder called disseminated intravascular coagulation
• high levels of chemicals in your blood due to the breakdown of tumour cells (tumour lysis syndrome) - you have regular blood tests to check for this

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, foods 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.

Alcohol

Paclitaxel contains small amounts of alcohol. This is not harmful to most people but talk to your team if you have alcohol problems.

Do not drive or operate machinery if you feel dizzy or drowsy.

Pregnancy and contraception

This treatment might harm a baby developing in the womb. It is important not to father a child while you're having treatment for testicular cancer. Talk to your doctor or nurse about effective contraception before starting treatment.

Men should use contraception during treatment and for 6 months after finishing treatment.

Loss of fertility

You may not be able to get someone pregnant after treatment with this drug. Talk to your doctor before starting treatment if you think you want to have a baby in the future. You may be able to store sperm before starting treatment.

Treatment for other conditions

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

Immunisations

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 one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can 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 the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

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