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Chemotherapy for testicular cancer
Chemotherapy uses anticancer, or cytotoxic, drugs to destroy cancer cells. It is sometimes used to treat testicular cancer. Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of chemotherapy. You may also receive other treatments.
Chemotherapy is given for different reasons. You may have chemotherapy to:
- destroy cancer cells in the body
- shrink a tumour before surgery (called neoadjuvant chemotherapy)
- destroy cancer cells left behind after surgery and reduce the risk of the cancer recurring (called adjuvant chemotherapy)
- treat cancer that comes back, or recurs, after treatments
- relieve pain or control the symptoms of advanced testicular cancer (called palliative chemotherapy)
Chemotherapy is usually a systemic therapy. This means that the drugs travel through the bloodstream to reach and destroy cancer cells all over the body, including those that may have broken away from the primary tumour in the testicle.
Chemotherapy drugs commonly used for testicular cancer
The following drugs and drug combinations may be used in chemotherapy for testicular cancer.
The most common chemotherapy combinations used to treat testicular cancer are:
- BEP is bleomycin (Blenoxane), etoposide (Vepesid, VP-16) and cisplatin (Platinol AQ). It is usually given through a needle in a vein (intravenously) every 3 weeks for 2–3 months, or 3 or 4 cycles. In some cases, 1 or 2 cycles of BEP may be given for stage I non-seminomas.
- EP is etoposide and cisplatin. EP is used when bleomycin affects the lungs (called pulmonary toxicity) or there is a high risk that it will cause lung damage. It is given intravenously every 3 weeks for 3 months, or 4 cycles.
- VIP is etoposide, ifosfamide (Ifex) and cisplatin. VIP may be used when bleomycin affects the lungs (called pulmonary toxicity) or there is a high risk that it will cause lung damage. It is given intravenously every 3 weeks for 3 months, or 4 cycles.
In rare cases, carboplatin (Paraplatin, Paraplatin AQ) may be offered instead of radiation therapy or active surveillance after orchiectomy for stage I seminomas. In these cases, 1 or 2 cycles of carboplatin are usually given intravenously.
If testicular cancer doesn’t respond to the above drugs or if it recurs, the following chemotherapy combinations may be used. These are sometimes called salvage, or second-line, chemotherapy.
- TIP is paclitaxel (Taxol), ifosfamide and cisplatin. It is given intravenously every 3 weeks for 3 months, or 4 cycles.
- VIP is etoposide, ifosfamide and cisplatin. It is given intravenously every 3 weeks for 3 months, or 4 cycles.
- VeIP is etoposide or vinblastine (Velbe), ifosfamide and cisplatin. It is given intravenously every 3 weeks for 3 months, or 4 cycles.
Mesna (Uromitexan) is a supportive drug that may be given to prevent urinary tract problems and protect the bladder from damage. It is often given when ifosfamide is used.
High-dose chemotherapy and stem cell transplant
High-dose chemotherapy with carboplatin and etoposide may be used if testicular cancer recurs after it is treated with standard-dose chemotherapy. After high-dose chemotherapy, a stem cell transplant is done to replace the stem cells that are damaged or destroyed by high-dose chemotherapy. The stem cell transplant uses stem cells from your own blood (called autologous peripheral blood stem cell transplant).
Palliative therapy is given to relieve symptoms, rather than to treat the cancer itself. Gemcitabine (Gemzar) may be given with oxaliplatin (Eloxatin), paclitaxel or both as palliative treatment for seminomas or non-seminomas. Etoposide taken by mouth (orally) is also an option for palliative chemotherapy.
Information about specific cancer drugs
Details on specific drugs change quite regularly. Find out more about sources of drug information and where to get details on specific drugs.
Questions to ask about chemotherapy
Providing rides to cancer treatment
For more than 50 years, the Canadian Cancer Society’s transportation program has enabled patients to focus their energy on fighting cancer and not on worrying about how they will get to treatment.