At a glance

Treatment: Etoposide + Ifosfamide + Cisplatin
When it may be used: VIP may be used for selected people with germ cell cancer.
How it is given: Etoposide, ifosfamide and cisplatin are given by drip into a vein.
Before you start: Tell the team about kidney or bladder problems, hearing changes, previous cancer treatment and any numbness.

What this treatment is and how it works

VIP combines three chemotherapy medicines. They act in different ways to damage genetic material or stop cells multiplying.

When it may be used

It is one option when the team chooses a plan without bleomycin or when prior treatment and risk features make VIP appropriate.

Before treatment

Discuss fertility preservation before the first cycle.

How treatment is given

The drugs are given through a vein over several treatment days. Fluids help protect the kidneys and mesna helps protect the bladder. You may receive a white-cell support injection after the chemotherapy days.

Tests and monitoring during treatment

Blood counts, kidney tests and salts in the blood are checked. The team may test hearing and ask about alertness, urination, tingling and symptoms between visits.

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.
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.
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.
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.

Other reported side effects

Report less urine, blood in urine or new hearing changes. Tell staff immediately if you develop dizziness, flushing or a rash during a drip.

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.

Tell the team if you pass much less urine than usual. Infection can become serious quickly while your blood counts are low.

When to seek urgent help

Call your hospital’s 24-hour cancer care number straight away for fever, chills, confusion, bleeding, reduced or bloody urine, worsening vomiting or inability to drink. 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

Prepare for the multi-day treatment

VIP is given over several visits or as an inpatient. Your team gives fluids and checks kidney function and blood salts during cisplatin. Ask how many days you need to plan for and whether any support injections or tests are scheduled after you leave.

Manage the medicines that go home with you

Some schedules include mesna after your ifosfamide drip. Ask for the exact times and check what to do if you vomit after taking it. Use your written nausea plan, including medicines for symptoms that occur after leaving the unit. Call if you cannot drink or take essential medicines.

Tell the team about hearing, urine or alertness changes

Report ringing, hearing difficulties, reduced urine or pain passing urine. Ifosfamide can affect the brain. Let a caregiver know to call right away for new confusion or significant drowsiness after a visit. A seizure or inability to wake needs emergency care.

Medicines, interactions and vaccinations

Discuss non-prescription painkillers, sedating drugs and supplements with the team. Check before vaccines. Use your current anti-sickness plan.

Everyday life

Allow time for treatment and recovery between blocks. Ask how much to drink at home and what to do if your team has already set a fluid limit.

Pregnancy, fertility and breastfeeding

Ask about sperm, egg or other fertility preservation where relevant and how long to use contraception or avoid breastfeeding.

After treatment

The team may check blood tumour markers and scans. Ask about hearing, nerve and kidney monitoring after your final cycle.

Frequently asked questions

Does VIP contain bleomycin?

VIP contains etoposide, ifosfamide and cisplatin. Ask why this combination was chosen.

Why do I need both fluids and mesna?

Fluids support the kidneys. Mesna helps protect the bladder from ifosfamide.

What if I feel confused?

Tell the nurse immediately or call the 24-hour cancer care number if you are at home. Ifosfamide can affect alertness and behaviour. A caregiver should call if you become unusually sleepy, confused or difficult to wake. Seek emergency help for a seizure or loss of consciousness.

Should I report brief ringing in my ears?

Yes. Tell the team promptly even if it comes and goes.

Will I need a white-cell support injection?

It is often part of a VIP plan. Ask when yours is due and who will give it.

Which tests show whether VIP is working?

The team may use tumour marker blood tests and scans, depending on your cancer.

Will I need a sperm storage appointment before my first cycle?

If you might wish to have children, ask promptly so the germ cell cancer team can discuss sperm storage before chemotherapy. Let it know if you already have a sample in storage from previous treatment.

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.