At a glance

Treatment: Paclitaxel + Ifosfamide + Cisplatin
When it may be used: TIP is a treatment option for selected people whose germ cell cancer has returned or continued growing after earlier treatment.
How it is given: Paclitaxel, ifosfamide and cisplatin are given by drip into a vein.
Before you start: Tell the team about previous reactions, numbness, hearing changes, kidney or bladder problems and any medicines that make you sleepy.

What this treatment is and how it works

Paclitaxel interferes with cell division. Ifosfamide and cisplatin damage the genetic material cells need to grow.

When it may be used

Your team will discuss the aim and alternatives.

Before treatment

Tell the team about previous reactions, numbness, hearing changes, kidney or bladder problems and any medicines that make you sleepy. Discuss fertility before treatment starts.

How treatment is given

The drugs are given through a vein on several days. Steroids and other medicines may be used before paclitaxel. Fluids and mesna help protect the kidneys and bladder.

Tests and monitoring during treatment

Blood counts, kidney tests, salts and urine are monitored. Tell the team about reduced urine, blood in urine, ringing in the ears, tingling or a change in alertness.

Side effects

Common or more frequent side effects

Changes in blood counts. Treatment can lower the white cells that fight infection, the red cells that carry oxygen and the platelets that stop bleeding. You may feel tired or get breathless sooner than usual. Let the unit know about nosebleeds, new bruises or small red or purple spots. Fever or shaking chills needs a call to the urgent number even if your next blood test is already booked.
Tingling, altered feeling or pain in hands and feet. Give examples of what has changed, such as difficulty with buttons, holding a cup or getting your balance on steps. Tell the team if the sensation lasts until the next visit. If temperature is hard to judge with your fingers or toes, take care around hot water and heating pads.
Urine changes. While you have ifosfamide, the team may check your urine and give fluids and mesna, a medicine that helps protect the bladder. Tell it about burning, bladder pain or visible blood even if you already had mesna. Mention reduced urine or new swelling so your team can assess kidney and fluid balance.
Nausea and vomiting after cisplatin. Cisplatin can cause nausea on the treatment day and on later days. Keep the prescribed anti-sickness timetable after going home. Ask which medicine to use if nausea breaks through. Contact the unit if you cannot drink or take essential medicines. The team may need to check hydration and kidney function.

Other reported side effects

Tell the nurse promptly about itching, dizziness, rash or breathing changes during paclitaxel. Ask how to take home medicines after each visit.

Serious effects to recognise

Changes in alertness or behaviour. Ifosfamide can affect the brain during treatment or soon afterwards. New confusion, unusual sleepiness, hallucinations or changes in behaviour need immediate help. Ask a caregiver to note when symptoms began. Call emergency services for a seizure or difficulty waking.
Hearing or balance changes. Platinum chemotherapy can cause ringing in the ears or hearing loss. Ask if you need a baseline or follow-up hearing test. Report new ringing, poorer hearing or changes that make it hard to follow conversations. Your team can check how this affects the next treatment.

Serious infection, allergic reactions and bladder or kidney injury can occur. Report blood in your urine or passing much less urine than usual.

When to seek urgent help

Call your hospital’s 24-hour cancer care number straight away for fever, shaking chills, confusion, reduced or bloody urine, new breathlessness or persistent vomiting. Follow your hospital’s written temperature instructions. If you have no written threshold, call at 37.5°C (99.5°F) or above, or below 36°C (96.8°F). Call if you feel very unwell even when your temperature is normal.

Seek emergency care for severe breathing difficulty, swelling of the face or throat, chest pain, collapse or bleeding that will not stop.

Practical advice for this treatment

Check the admission and medication plan

TIP combines paclitaxel, ifosfamide and cisplatin. Ask which days you need to be in hospital and if there are any injections or blood tests after you go home. Review the medicines given before paclitaxel and report any previous infusion reaction. Fluids with treatment may mean you pass urine more often in hospital.

Know why mesna and fluid checks matter

Mesna protects the bladder during ifosfamide treatment. Tell the nurse about new burning or blood on urinating. If you have mesna doses to take after discharge, check exactly when they are due and call if you miss one. The team also checks urine output and kidney function during cisplatin.

Report symptoms you already have

Save a record of any numbness, poor balance, hearing loss or ringing in the ears from earlier chemotherapy. Let the nurse know if any of these worsen. Tell the team urgently about new confusion, extreme drowsiness or unusual behaviour after ifosfamide.

Medicines, interactions and vaccinations

Ask before starting non-prescription painkillers, sedatives, supplements or vaccines. Tell the team if you cannot take any mesna prescribed for home use.

Everyday life

Plan for treatment days and travel with some flexibility. Keep your hospital contact number and report hearing or nerve changes early.

Pregnancy, fertility and breastfeeding

Ask about fertility preservation and pregnancy precautions. Obtain advice specific to your plan before breastfeeding.

After treatment

Ask when the team will check tumour markers and scans. Keep follow-up for hearing, kidney or nerve symptoms that continue after treatment.

Frequently asked questions

How is TIP different from VIP?

TIP contains paclitaxel where VIP contains etoposide. Ask why your team chose one.

Why is there medicine before paclitaxel?

The team may prescribe it to lower the risk of an infusion reaction.

Which symptoms might be from ifosfamide?

Confusion, unusual sleepiness or blood in urine need urgent assessment.

Why do I get extra fluids?

They help protect the kidneys during cisplatin treatment.

What if numbness affects walking?

Tell the team before the next cycle or earlier if the change is sudden.

Will I need other treatment after TIP?

Ask when the team will review response and discuss possible next steps.

Can I go back to driving immediately after a treatment visit?

Ask the unit before the first visit and arrange a lift if it recommends one. Medicines given before paclitaxel can make you sleepy. Tell staff before leaving if you feel unsteady, unusually sleepy or confused.

Individual medicine guides

Sources and further reading

Read this guide alongside your hospital’s plan. Ask your pharmacist to confirm the exact product dispensed in India and follow the instructions for that product.