This information is about a chemotherapy treatment used for several different types of cancer called etoposide and cisplatin (platinum), also known as EP or PE. 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.

The chemotherapy drugs used in this treatment are etoposide and cisplatin.

Before you start treatment you will need a blood test, either on the same day, or several days beforehand. You will also be seen by a doctor, specialist nurse or pharmacist. If the blood tests are normal the pharmacy will prepare your drugs.

The nurse will then put a fine 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 fine plastic tube which 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 this to you.

Once your chemotherapy is ready you will be given some anti-sickness (anti‑emetic) drugs. These are usually given by injection through the cannula, central line or PICC line, which is connected to a drip (infusion), though some anti-sickness medicines may also be given as tablets.

Before having the chemotherapy you will be given a drip of sterile salt water (saline) to keep your kidneys working normally. This is because cisplatin can affect how the kidneys work and taking the fluids can help prevent any damage. This infusion is sometimes referred to as pre-hydration.

You will then be given the chemotherapy drugs:

• Etoposide is a colourless fluid that is given as an infusion (taking an hour), or as capsules to be taken by mouth. It is available as 50mg and 100mg pale pink capsules, which should be swallowed whole with plenty of water. The 50mg capsules are smaller than the 100mg ones. If you have trouble swallowing the 100mg capsules tell your doctor so that you can be given the smaller ones.

• Cisplatin is a colourless fluid that is given as an infusion.

Etoposide may be given first or following the pre-hydration. After the chemotherapy has finished you will be given more saline through the drip for about one hour (post-hydration).

Before you go home, the cannula will be removed and you will be given some anti-sickness medicines to take with you. It is important to take these as directed, even if you are not feeling sick, as some anti-sickness medicines are much better at preventing sickness than at stopping it once it has started. It is also important that you drink plenty of fluids (approximately eight glasses in the day following the cisplatin). This helps to keep your kidneys working well.

You may hear your doctor use the word 'regimen' (eg the EP regimen) when talking about your chemotherapy. This just means the whole plan or schedule of the particular chemotherapy treatment that you are receiving.

There are different ways of giving EP chemotherapy. You can ask your nurse or doctor to explain your particular regime.

A typical way of giving EP chemotherapy is as follows:

On day one of your treatment you will be given infusions of both cisplatin and etoposide, as described above. You will then be given etoposide capsules to take at home over the next two days (days two and three). After this you will have a rest period for 18 days. This completes a cycle of your treatment.

The treatment will be repeated after the rest period, which will be three weeks after your first infusions. This is the next cycle of your chemotherapy. Up to six cycles of treatment may be given, over a period of 4–5 months.

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

Lowered resistance to infection EP 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 straight away 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.

Bruising or bleeding EP 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 EP you may become anaemic. This can make you tired and breathless. Let your doctor or nurse know if these are a problem.

Feeling sick (nausea) and being sick (vomiting) Your doctor can prescribe very effective anti-sickness (anti-emetic) medicines to prevent or reduce nausea and vomiting. If the sickness is not controlled, or if it continues, tell your doctor. They can prescribe other anti-sickness medicines which may be more effective. Some anti-sickness medicines can cause constipation. Let your doctor know if you experience any side effects.

Your kidneys may be affected Usually this does not cause any symptoms and the effect on your kidneys is mild, but if the effect is severe, the kidneys can be permanently damaged unless the treatment is stopped. For this reason your kidneys will be checked by a blood test before each treatment.

You will be given plenty of fluid into a vein before and after the treatment to keep your kidneys working normally.

Hair loss This usually starts 3–4 weeks after the first dose of etoposide, although it may happen earlier. Hair will usually be lost completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. This is temporary and your hair will regrow once the treatment ends.

Numbness or tingling in hands or feet This is due to the effect of cisplatin on nerves and is known as peripheral neuropathy. You may notice that you have difficulty doing up buttons or similar fiddly tasks. Tell your doctor if you notice any numbness or tingling in your hands or feet. The side effect usually disappears slowly a few months after the treatment ends.

Changes in hearing You may have ringing in the ears (tinnitus) and you may lose the ability to hear some high-pitched sounds. Again, this effect usually decreases when the treatment ends, although in a small number of cases it may be permanent. Tell your doctor if you notice any loss of hearing or tinnitus.

Sore mouth and ulcers Your mouth may become sore, 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 doctor if you have any of these problems, as they can prescribe special mouthwashes and medicines to prevent or clear any mouth infection.

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

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

Tiredness and feeling of weakness Many people feel extremely tired (fatigued) during chemotherapy, especially towards the end of treatment. It is important to allow yourself plenty of time to rest.

Skin changes Etoposide can cause a rash, which may be itchy. Your doctor can prescribe medicine to help with this. Let your doctor know if this happens. Also, your skin may darken due to an excess production of pigment. It usually returns to normal after the treatment has finished.

Allergic reaction Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, redness or darkening of the face, dizziness, a headache, breathlessness, anxiety and a need to pass urine. You will be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse if you have any of these effects.

Etoposide can cause a second cancer (usually a type of acute leukaemia), to develop years later, although this is very rare. 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 straightaway if you have any of these symptoms. However, most clots can usually be successfully treated by using drugs which thin the blood. Your doctor or nurse can give you more information.

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

Pain at injection site While etoposide is being given, it can cause pain at the place where the injection is given, or along the vein. If you feel pain, tell your doctor or nurse.

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

Contraception It is not advisable to become pregnant or father a child while taking EP as it may harm the developing foetus. It is necessary to use effective contraception whilst taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

• It is important to take your capsules at the right times. You must take them as directed by your doctor.
• If the capsules leak, it is important not to touch their contents.
• Keep the capsules in a safe place where children cannot reach them, as etoposide could harm them.
• If your doctor decides to stop the treatment, return any remaining capsules to the pharmacist. Do not flush them down the toilet or throw them away.
• If you are sick just after taking the capsules, let your doctor know as you may need to take another dose. Do not take another capsule without first informing your doctor.
• If you forget to take a capsule do not take a double dose. Let your doctor know and keep to your regular dose schedule.

This section is based upon our etoposide and cisplatin 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.