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Treatment Name: VIP (Etoposide + Ifosfamide + Cisplatin)

VIP (Etoposide + Ifosfamide + Cisplatin) is a Chemotherapy Regimen for Testicular Cancer

How does VIP work?
Each of the medications in VIP is designed to slow the growth of and kill cancer cells.

V - VP 16 (Etoposide)
I - Ifosfamide (Ifex®)
P - Platinol® (Cisplatin)

Goals of therapy:
VIP is given to shrink tumors and decrease the signs and symptoms of testicular cancer. VIP is commonly given with the goal of cure.

Schedule

  • VP-16 (Etoposide) intravenous (I.V.) infusion is given over 1 hour on days 1, 2, 3, 4 and 5
  • Ifosfamide I.V. infusion is given over 3 hours on days 1, 2, 3, 4, and 5
  • Platinol® (Cisplatin) I.V. infusion is given over 1 hour on days 1, 2, 3, 4 and 5
  • Mesna I.V. infusion is given over 24 hours on days 1, 2, 3, 4, and 5

Typically, etoposide, ifosfamide, and cisplatin are all given on days 1, 2, 3, 4 and 5 of each cycle.

Mesna is not a chemotherapy agent. It binds to and neutralizes a toxic metabolite of ifosfamide known as acrolein

VIP is usually requires a 5-6 day stay in the hospital.

VIP is repeated every 21 days. This is known as one cycle. Each cycle may be repeated up to 4 times, depending upon the stage of the disease and specific type of testicular cancer. Duration of therapy may last up to 4 months, depending upon response, tolerability, and number of cycles prescribed.

Click here for common starting doses

Side Effects

In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported side effects with VIP are shown here:

Side effect videos Side Effect Videos
Nausea and VomitingNausea and VomitingHair LossHair LossFatigue Fatigue Neutropenic FeverNeutropenic Fever

Monitoring

How often is monitoring needed?
Labs (blood tests) may be checked before and during therapy as well as periodically in follow-up after each cycle. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), blood magnesium levels, plus any others your doctor may order. A urinalysis may also be done daily while receiving ifosfamide to check for blood in the urine.

How often is imaging needed?
Imaging may be checked before treatment, immediately after treatment is finished, and during routine follow-up. Imaging may include: computed tomography (CT) scan, magnetic resonance imaging (MRI), bone scan, or x-ray.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue VIP as planned, or delay or switch therapy.

ChemoExperts Tips

  • Intravenous (I.V.) fluids may be given while receiving cisplatin and ifosfamide to maintain good hydration and protect against kidney damage. These fluids often contain electrolytes such as potassium and magnesium
  • Treatment with BEP may decrease sperm count. Prior to starting treatment, discuss with your doctor options for sperm banking, if interested
  • Typically, filgrastim (Neupogen®) or pegfilgrastim (Neulasta®) is given after chemotherapy to stimulate production of white blood cells, avoid periods of neutropenia, and prevent infection
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for testicular cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications.

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for VIP (Etoposide + Ifosfamide + Cisplatin), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for VIP (Etoposide + Ifosfamide + Cisplatin). Depending upon your income, they may be able to help cover the cost of:

  • VP-16
  • Ifosfamide
  • Cisplatin

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as VIP (Etoposide + Ifosfamide + Cisplatin) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with VIP (Etoposide + Ifosfamide + Cisplatin)

Individual Drug Label Information

VP-16 (Etoposide)

  • Etoposide (VP-16) Is an intravenous (I.V.) infusion that is typically given over 30-60 minutes or in some instances, as a continuous infusion
  • This drug interacts with grapefruit juice and can cause increased exposure to etoposide if taken together
  • Dosage adjustments may be required for decreased kidney or liver function
General VP-16 (Etoposide) Side Effects
  • Often causes temporary hair loss, which is usually reversible after stopping etoposide therapy
  • Gastrointestinal side effects such as diarrhea, mouth sores, nausea and upset stomach can be common
  • Although rare, it has been linked to the development of acute leukemia (2-12%) and typically occurs 2-3 years after therapy
  • May cause low blood counts (white blood cells, red blood cells, and platelets)
  • Click on the VP-16 (etoposide) package insert below for reported side effects and potential drug Interactions

Side Effect Videos
DiarrheaDiarrheaHair LossHair LossFatigue Fatigue BleedingBleedingAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

Ifosfamide (Ifex®)

  • Ifosfamide is an intravenous (I.V.) infusion
  • Has been linked to the development of other cancers in a small number of people 
  • Your blood counts will be monitored closely while on therapy and your chemotherapy may need to be delayed due to low red blood cells, white blood cells, and platelets
  • Symptoms of neurotoxicity from ifosfamide include tiredness, confusion, dizziness, mood changes, hallucinations, seizure, and coma. You will be checked for any signs of neurotoxicity prior to receiving each dose of ifosfamide. If these occur during treatment, ifosfamide infusion should be interrupted until the symptoms go away
  • Bladder irritation may occur and result in blood in the urine. This may appear as pink urine, or bright red, depending upon how much blood is being lost. Drink plenty of fluids (1-2 liters/day), especially during the days when ifosfamide is given. Frequent urination will also help flush the bladder and avoid bladder irritation
  • Your kidney function will be monitored while on therapy with ifosfamide. Dosage adjustments may be required for decreased kidney function
  • A smaller dosage may be required for patients receiving hemodialysis
  • May decrease the ability to become pregnant. Fertility preservation is recommended in couples wishing to become pregnant
  • Has been linked to the development of other cancers in a small number of people
General Ifosfamide (Ifex) Side Effects 
  • Can cause lung toxicity leading to decreased lung function
  • Commonly causes hair loss, which is usually reversible
  • Has been linked to the development of other cancers in a small number of people
  • Low white blood cell count which can increase the risk of infection
  • Nausea or vomiting, which can be acute (first 24 hours) or delayed (Days 2 – 5)
  • Click on the Ifosfamide (Ifex) package insert below for reported side effects and possible drug iteractions

Side Effect Videos
DiarrheaDiarrheaHair LossHair LossFatigue Fatigue PainPainAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

Cisplatin (Platinol®)

  • Cisplatin is an intravenous (I.V.) infusion that is typically given over one to two hours
  • Cumulative toxicity to kidneys from cisplatin can be severe 
  • Other toxicities from multiple doses are:  low blood counts, nausea, vomiting, and hearing loss
  • Dosage adjustments may be required for poor kidney function or bone marrow toxicity (low blood counts) 
  • Cisplatin is hazardous to a human fetus; women should avoid pregnancy while on this drug 
  • Women should not breast-feed while on cisplatin; it has been reported to be in human milk 
  • Patients on anticonvulsant drugs may have decreased levels while on cisplatin 
General Cisplatin (Platinol) Side Effects 
  • Kidney problems (nephrotoxicity), especially in elderly patients. 
  • Nausea and vomiting, both acute (within first 24 hours) and delayed (two to five days after infusion) 
  • Diarrhea 
  • Low blood cell counts (myelotoxicity, acute leukemia)
  • Hearing problems- ringing ears.  All patients should have a baseline hearing test done.  All children should have hearing test done before each dose and for several years after therapy is complete 
  • Low blood electrolytes:  magnesium, potassium, calcium, sodium, and phosphate
  • Nerve pain 
  • Vision problems; improvement and/or complete recovery usually occurs after stopping therapy 
  • Liver toxicity; recovery usually occurs after stopping therapy 
  • Click on the cisplatin (Platinol) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaFatigue Fatigue PainPainAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

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References

1. Nichols CR, Catalano PJ, Crawford ED, et al. Randomized Comparison of Cisplatin and Etoposide and Either Bleomycin or Ifosfamide in Treatment of Advanced Disseminated Germ Cell Tumors: An Eastern Cooperative Oncology Group, Southwest Oncology Group, and Cancer and Leukemia Group B Study. J Clin Oncol. 1998;16:1287-1293.

2. Hinton S, Catalano PJ, Einhorn LH, et al. Cisplatin, etoposide and either bleomycin or ifosfamide in the treatment of disseminated germ cell tumors: final analysis of an intergroup trial. Cancer. 2003;97:1869-1875.

Created: August 31, 2016 Updated: August 31, 2016

What is Testicular Cancer?

A disease of the germ cells found in the testicles. Testicular cancer is most commonly diagnosed in males ages 15 - 35 and is very rarely seen in elderly men.

Currently, it is not known what causes testicular cancer, whether it is inherited or environmental. The stage of testicular cancer can vary at diagnosis and throughout treatment. Stages of testicular cancer include stages I, II, and III. The effectiveness of the treatment may depend upon the stage at diagnosis. With surgery and chemotherapy, testicular cancer is often curable.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What is Acrolein?

Acrolein is a breakdown product (metabolite) of ifosfamide. If too much acrolein builds up in the bladder, it destroys the cells lining the bladder. Mesna helps lessen the risk of this side effect by binding to and neutralizing acrolein

Common Starting Doses

  • VP-16 (Etoposide) 75 mg/m2 intravenous (I.V.) infusion is given over 1 hour on days 1, 2, 3, 4 and 5
  • Ifosfamide 1200 mg/m2 I.V. infusion is given over 3 hours on days 1, 2, 3, 4, and 5
  • Platinol® (Cisplatin) 20 mg/m2 I.V. infusion is given over 1 hour on days 1, 2, 3, 4 and 5
  • Mesna 1200 mg/m2 I.V. infusion is given over 24 hours on days 1, 2, 3, 4, and 5

Clinical Studies

If you are interested in reading the clinical trials results, please click on references below:

1. Nichols CR, Catalano PJ, Crawford ED, et al. Randomized Comparison of Cisplatin and Etoposide and Either Bleomycin or Ifosfamide in Treatment of Advanced Disseminated Germ Cell Tumors: An Eastern Cooperative Oncology Group, Southwest Oncology Group, and Cancer and Leukemia Group B Study. J Clin Oncol 1998;16:1287-1293.

2. Hinton S, Catalano PJ, Einhorn LH, et al. Cisplatin, etoposide and either bleomycin or ifosfamide in the treatment of disseminated germ cell tumors: final analysis of an intergroup trial. Cancer. 2003;97:1869-1875.

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium

Tumor lysis syndrome occurs when many cancer cells die quickly and release their contents into the bloodstream. Many times the body has the ability to flush these substances out through the kidneys or metabolize them via the liver. However, sometimes the body needs medicines to help eliminate these substances and to prevent organ damage.

Tumor lysis syndrome occurs when many cancer cells die quickly and release their contents into the bloodstream. Many times the body has the ability to flush these substances out through the kidneys or metabolize them via the liver. However, sometimes the body needs medicines to help eliminate these substances and to prevent organ damage.