VIP chemotherapy is a specific combination of three powerful medications used to treat certain cancers. The acronym “VIP” represents etoposide, ifosfamide, and cisplatin. This regimen is primarily used to treat advanced or recurrent testicular cancer, a type of germ cell tumor. The goal of VIP therapy is to shrink tumors and reduce cancer symptoms, often aiming for a cure.
The Components of VIP Chemotherapy
Etoposide is a chemotherapy drug categorized as a topoisomerase inhibitor. It works by interfering with an enzyme called topoisomerase II, responsible for DNA replication and repair within cancer cells. By damaging the DNA, etoposide prevents cancer cells from growing and dividing, leading to their destruction.
Ifosfamide is an alkylating agent. It works by adding an alkyl group to DNA, specifically targeting the guanine bases in the DNA strands. This action damages the DNA, preventing cancer cells from replicating and causing cell death.
Cisplatin is a platinum-based chemotherapy drug. It functions by forming cross-links within the DNA of cancer cells, which disrupts the normal structure and function of DNA. This damage prevents cancer cells from dividing and growing, leading to cell death.
The Treatment Process
VIP chemotherapy is administered in cycles, lasting 21 days. Patients receive a total of four cycles, so the entire treatment course spans about three months. The chemotherapy drugs are given intravenously, delivered directly into the bloodstream. This can be done through a central line, PICC line, or portacath. These lines are inserted into a large vein and remain in place for treatment.
On days 1 through 5 of each 21-day cycle, patients receive etoposide, ifosfamide, and cisplatin. Etoposide is infused over one hour, while cisplatin is administered over one to two hours. Ifosfamide infusions take between one and four hours.
Patients receive supportive medications during VIP chemotherapy to manage side effects. Mesna is given with ifosfamide to protect the bladder from irritation and bleeding caused by ifosfamide’s toxic metabolite, acrolein. Mesna can be given as a continuous intravenous drip or oral tablets.
Another supportive medication is Granulocyte-Colony Stimulating Factor (G-CSF), a growth factor. G-CSF helps the body produce white blood cells, important for fighting infections. It is given as an injection under the skin, often starting around day 6 of each treatment cycle. Patients also receive intravenous fluids for several hours before and after each cisplatin treatment, and are encouraged to drink about two liters of water over 24 hours to protect their kidneys.
Managing Side Effects and Monitoring
VIP chemotherapy can cause a range of side effects due to its impact on rapidly dividing cells, including healthy ones. A common side effect is myelosuppression, a reduction in blood cell counts. This can manifest as low white blood cells (neutropenia), increasing infection risk; low red blood cells (anemia), causing breathlessness and paleness; or low platelet counts (thrombocytopenia), increasing bleeding risk.
To manage low white blood cell counts, G-CSF injections are given to stimulate white blood cell production and reduce the risk of infection. In cases of severe anemia, blood transfusions may be needed. For thrombocytopenia, platelet transfusions may be considered to prevent or treat bleeding.
Nausea and vomiting are common side effects, and patients are given anti-sickness medications or antiemetics to prevent and control symptoms. Patients should take these medications as prescribed, even if not feeling sick, to prevent symptoms from starting. Hair loss is another common side effect, usually temporary.
Damage to organs such as the kidneys and liver can occur. Kidney function is supported by administering extra intravenous fluids before and after cisplatin, and patients are encouraged to drink plenty of water. Liver changes are mild and often return to normal after treatment. Regular blood tests monitor kidney and liver function throughout the treatment course.
Ongoing monitoring is an important part of VIP chemotherapy to track health and treatment response. Regular blood tests are conducted before and during each cycle. These tests include a complete blood count (CBC) to check levels of white blood cells, red blood cells, and platelets; comprehensive metabolic panels (CMP) to assess kidney and liver function, and electrolyte levels such as sodium and magnesium; and urine tests to check for bladder issues related to ifosfamide. Imaging scans may be done before, immediately after, and during follow-up to assess the treatment’s effectiveness.