This information is about a chemotherapy treatment called BEP that is used to treat testicular cancer or a rare type of ovarian cancer. It describes the drugs used, how they are given and some of the possible side effects. If you have any questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

BEP is named after the initials of the chemotherapy drugs used, which are:

• bleomycin 
• etoposide 
• cisplatin, which contains platinum.

BEP chemotherapy is given to you during a short stay in hospital. Before you start treatment you will need to have a blood test, either on the same day, or a day or two beforehand. You will also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy drugs. This may take a couple of hours.

When you begin your treatment, the nurse will put a thin flexible tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful, but it should not take long. Some people have their chemotherapy given through a thin plastic tube that is inserted under the skin into a vein near the collarbone (central line), or passed through a vein in their arm (PICC line). Your doctor or nurse will explain more about this to you.

You will be given an anti-sickness (anti-emetic) drug as tablets or by injection through the cannula, central line or PICC line, which is connected to a drip (infusion). All three chemotherapy drugs - bleomycin, etoposide and cisplatin - are usually given to you as a drip (infusion), which will be connected to your line or your cannula. The bleomycin may sometimes be given as an injection into the muscle (intramuscularly). If you find this painful it can be given with a local anaesthetic.

Before and after treatment with cisplatin, you will be given plenty of fluid through your drip to keep your kidneys working normally.

BEP chemotherapy can be given in different ways. Your doctor may use the word 'regimen' (eg the BEP regimen) when talking about your chemotherapy. This means the whole plan, or schedule, of the particular chemotherapy treatment that you are having.

There are descriptions of two different schedules for giving BEP below. You can ask your doctor or nurse to tell you whether you are having one of these. If not, they will be able to give you details of your regimen.

Schedule A

On the first day of your treatment (day 1) you will be given etoposide and cisplatin (as described above). The next day (day 2) you will have all three drugs: bleomycin, etoposide and cisplatin. On the third day you will have etoposide alone. After this, you can usually go home.

Five days later (day 8) you will come back as a day patient to have bleomycin. After this you will have no treatment for a week. You will have bleomycin again on day 15. You will then have a rest period with no chemotherapy for a week. This completes what is called a cycle of your treatment. Each cycle lasts three weeks.

Schedule B

On the first day of your treatment (day 1) you will be given etoposide and cisplatin. The next day (day 2) you will have all three drugs: bleomycin, etoposide and cisplatin. On the third, fourth and fifth days, you will have etoposide and cisplatin again. After this, you can usually go home.

A week after you started (day 8), you will return to hospital as a day patient to have bleomycin. You will then have a rest period with no chemotherapy until a week later (day 15), when you will have bleomycin again. After this you will have another week without chemotherapy. This completes a cycle of your treatment. Each cycle lasts three weeks.

Usually 2–4 cycles of BEP are given over a period of 2–3 months. This makes up a course of treatment.

Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described below will not affect everyone having BEP chemotherapy. We have outlined the most common side effects, so that you can be aware of them if they occur. However, we have not included those that are rare and therefore unlikely to affect you. If you notice any effects that you think may be due to the drugs, but which are not listed below, please let your nurse or doctor know.

Lowered resistance to infection BEP can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, with your resistance to infection usually reaching its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels before your next cycle of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

• your temperature goes above 38ºC (100.5ºF)
• you suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy to make sure that your number of white blood cells has returned to normal. Occasionally, it may be necessary to delay treatment if your number of blood cells (blood count) is still low.

You may be given injections of G-CSF to help prevent the number of white blood cells getting too low. G-CSF is a type of protein that can stimulate the bone marrow to produce white blood cells. G-CSF is given as an injection under the skin (subcutaneously).

Bruising or bleeding BEP can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.

Anaemia (low number of red blood cells) While having treatment with BEP you may become anaemic. This may make you feel tired and breathless. Let your nurse or doctor know if this is a problem for you.

Feeling sick (nausea) and being sick (vomiting) Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or reduce nausea and vomiting. It is important to take these as directed, even if you are not feeling sick. This is because some anti-sickness drugs are much better at preventing sickness than stopping it once it has started. If the sickness is not controlled, or if it continues, tell your doctor. They can prescribe other anti-sickness drugs that may be more effective. Some anti-sickness drugs may cause constipation. Let your doctor or nurse know if this is a problem.

Tiredness Many people feel extremely tired (fatigued) during chemotherapy, particularly towards the end of treatment. This is a very common side effect and it is important to try to get as much rest as you need.

Hair loss This usually starts 3–4 weeks after the first cycle of treatment. Hair usually falls out completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and your hair will start to grow again once the treatment has finished.

Sore mouth and ulcers Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can give you special mouthwashes and medicine to prevent or clear any mouth infection.

Taste change You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.

Numbness or tingling in hands or feet This is due to the effect of cisplatin on nerves and is known as peripheral neuropathy. Tell your doctor if you notice these side effects. This problem usually improves slowly a few months after the treatment has finished.

Skin changes Rarely, your skin may darken. If it does, it usually goes back to normal a few months after treatment has finished. Bleomycin can cause a rash which may be itchy. Your doctor can prescribe medicine to help with this.

Sometimes areas which have previously been treated with radiotherapy may become red and sore. Let your doctor know if this happens.

Your kidneys may be affected Usually this does not cause any symptoms and the effect on the kidneys (which is due to cisplatin) is normally mild. Rarely, it may cause permanent damage to the kidneys unless the treatment is stopped. Before and after each treatment, your kidneys will be checked by a blood test and you will be given plenty of fluid through a drip to keep your kidneys working normally. It is important that you also drink plenty of fluids during and after your treatment. Your urine may also be measured.

Changes in hearing You may experience ringing in the ears (tinnitus) and you may be unable to hear some high-pitched sounds. This is due to cisplatin and, again, it usually improves when the treatment is over. Tell your doctor if you notice any loss of hearing or ringing in your ears.

Diarrhoea If you have diarrhoea, it can usually be controlled easily with medicine. Let your doctor know if it is severe or if it continues. Try to drink as much as 2–3 litres of fluid a day to replace the fluid you are losing.

Changes in nails Your nails may become darker and white lines may appear on them. These changes usually grow out over a few months once the treatment has finished.

Fevers and chills This may happen several hours after bleomycin is given, but does not usually last for long. Your doctor may give you a steroid drug (hydrocortisone) beforehand to prevent this from happening.

Changes to the lungs Bleomycin can cause serious lung problems. These can happen during treatment or after it has finished. They are more likely to happen if you smoke. Your doctor can give you more information about this potential side effect.

Let your doctor know if you notice any coughing or breathlessness.

Always let your doctor or nurse know about any side effects that you have. There are usually ways in which they can be controlled or improved.

Very rarely, etoposide may cause a second cancer, usually a type of acute leukaemia, to develop years later. Your nurse or doctor can discuss this with you.

Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it is important to tell your doctor staightaway if you have any of these symptoms. However, most clots can usually be successfully treated by using drugs to thin the blood. Your doctor or nurse can give you more information.

Other medicines Some other medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Fertility Your ability to get pregnant or father a child may be affected by this treatment. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to father a child while having this treatment, as the developing foetus may be harmed. It is important to use effective contraception while taking these drugs, and for at least a few months afterwards. Again, discuss this with your doctor or nurse.

This section is based upon our BEP chemotherapy factsheet which has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (35th edition). Eds. Sweetman et al, Pharmaceutical Press, 2007.
• British National Formulary (54th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2007.
• The Chemotherapy Source Book (3rd edition). Ed. Perry. Lippincott, Williams and Wilkins, 2001.

For further references, please see the general bibliography.