Chemotherapy for testicular cancer

Chemotherapy uses anticancer (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
• destroy cancer cells left behind after surgery and reduce the risk that the cancer will come back (relapse) (called adjuvant chemotherapy)
• treat cancer that comes back 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 blood to reach and destroy cancer cells all over the body, including those that may have broken away from the original tumour in the testicle.

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 – bleomycin, etoposide (Vepesid) and cisplatin
• EP – etoposide and cisplatin
• VIP – etoposide, ifosfamide (Ifex) and cisplatin

EP and VIP are used when bleomycin affects the lungs (called pulmonary toxicity) or there is a high risk that it will cause lung damage.

In rare cases, carboplatin may be offered instead of radiation therapy or active surveillance after a radical inguinal orchiectomy (an orchiectomy) for stage 1 seminomas.

If testicular cancer doesn’t respond to drugs in earlier treatments or if the cancer comes back, you may be given another chemotherapy combination (called salvage chemotherapy). You may be offered one of the following combinations:

• TIP – paclitaxel, ifosfamide and cisplatin
• VIP – etoposide, ifosfamide and cisplatin
• VeIP – vinblastine, ifosfamide and cisplatin

Almost all chemotherapy for testicular cancer is given through a needle into a vein (intravenously).

Medicine to help prevent blood clots or infections may also be given along with chemotherapy.

High-dose chemotherapy with carboplatin and etoposide may be used if testicular cancer comes back 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). The stem cells are collected from your blood before high-dose chemotherapy.

Palliative chemotherapy is given to relieve symptoms and extend your life, rather than to treat the cancer itself. Gemcitabine may be given with oxaliplatin, paclitaxel or both as palliative treatment for seminomas or non-seminomas. Etoposide taken by mouth (orally) is also an option for palliative chemotherapy.

Side effects can happen with any type of treatment for testicular cancer, but everyone’s experience is different. Some men have many side effects. Others have few or none at all. Your oncologist will discuss possible side effects in great detail with you.

Chemotherapy may cause side effects because it can damage healthy cells as it kills cancer cells. If you develop side effects, they can happen any time during, immediately after or a few days or weeks after chemotherapy. Sometimes late side effects develop months or years after chemotherapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of chemotherapy will depend mainly on the type of drug, the dose, how it’s given and your overall health. Some common side effects of chemotherapy drugs used for testicular cancer are:

• nausea and vomiting
• low blood cell counts
• sore mouth and throat
• loss of appetite and weight loss
• diarrhea
• hair loss
• fertility problems and sexual problems for men
• bladder problems
• kidney problems
• lung problems
• nervous system problems, such as numbness or tingling of the hands and feet (called peripheral neuropathy), hearing damage and erectile dysfunction (impotence)
• fatigue
• heart problems, such as high blood pressure and high blood cholesterol levels (called metabolic syndrome)
• second cancers, such as leukemia

Tell your healthcare team if you have these side effects or others you think might be from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.

Find out more about chemotherapy and side effects of chemotherapy. To make the decisions that are right for you, ask your healthcare team questions about chemotherapy.