VEIP
Regimen Monograph
Regimen Name | Drug Regimen | Cycle Frequency | Premedication and Supportive Measures | Dose Modifications | Adverse
Effects | Interactions | Drug Administration and Special Precautions | Recommended Clinical Monitoring | Administrative
Information | References | Other Notes | Disclaimer
A - Regimen Name
VEIP Regimen
VinBLAStine-Ifosfamide-PLATINOL ® (CISplatin)
Disease Site Genitourinary - Testis
(Salvage Therapy)
Intent Curative
Regimen Evidence-Informed :
Category
Regimen is considered appropriate as part of the standard care of patients;
meaningfully improves outcomes (survival, quality of life), tolerability or costs
compared to alternatives (recommended by the Disease Site Team and
national consensus body e.g. pan-Canadian Oncology Drug Review,
pCODR). Recommendation is based on an appropriately conducted phase III
clinical trial relevant to the Canadian context OR (where phase III trials are not
feasible) an appropriately sized phase II trial. Regimens where one or more
drugs are not approved by Health Canada for any indication will be identified
under Rationale and Use.
Rationale and First or second line treatment of testicular cancer with curative intent
Uses
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B - Drug Regimen
CISplatin 20 mg /m² IV Daily for 5 days - start
(Round to nearest 1 mg) on day 1
ifosfamide 1200 mg /m² IV Daily for 5 days - start
Any use of the information is subject, at all times, to CCO’s Terms and Conditions.
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(Round to nearest 25 mg; on day 1
maximum dose = 1.75 g)
vinBLAStine 0.11 mg /kg IV Days 1 to 2
(Round to nearest 0.1 mg)
(Continued on next page)
mesna 240 mg /m² IV Days 1 to 5,
(Round to nearest 10 mg) immediately before
THEN ifosfamide
mesna 240 mg /m² IV Days 1 to 5, at 4 and
(Round to nearest 10 mg) 8 hours after
May substitute doses at 4 and 8 hours post-ifosfamide with: ifosfamide
mesna 480 mg /m² PO Days 1 to 5, at 4 and
(Round to nearest 10 mg) 8 hours after
ifosfamide
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C - Cycle Frequency
REPEAT EVERY 21 DAYS
For a usual total of 3 to 4 cycles
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D - Premedication and Supportive Measures
Antiemetic Regimen: High
Febrile Neutropenia High
Risk:
Other Supportive Care:
Fertility counselling and sperm bank should be routinely offered.
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E - Dose Modifications
Doses should be modified according to the protocol by which the patient is being treated. The
following recommendations are in use at some centres.
As dose modification of VIP treatment may compromise its efficacy, it is recommended that
modification of this regimen be done only after discussion with a medical oncologist
experienced in the treatment of testicular cancer.
Dosage with toxicity
Hematologic Toxicities: Primary prophylaxis with G-CSF at dose 5–10mcg/kg SC x 10 days,
starting on Day 6 is recommended, because of the extreme myelosuppressive effect of the regimen,
especially when given as second-line.
Hepatic Impairment
Dosage modification should be individualized.
Renal Impairment
Dosage modification should be individualized.
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F - Adverse Effects
Refer to CISplatin, ifosfamide, vinBLAStine, mesna drug monograph(s) for additional details of
adverse effects
Most Common Side Effects Less Common Side Effects, but may be Severe
or Life Threatening
Nausea and vomiting Arrhythmia
Nephrotoxicity (may be severe) Cardiotoxicity
Electrolyte abnormalities Arterial thromboembolism
Neurotoxicity and ototoxicity Venous thromboembolism
(may be severe) Hypersensitivity
Myelosuppression ± infection / ↑ LFTs
Any use of the information is subject, at all times, to CCO’s Terms and Conditions.
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bleeding (may be severe) Pancreatitis
Hyperuricemia Pneumonitis
Alopecia SIADH
Encephalopathy, neuropathy Rhabdomyolysis
(may be severe) Secondary malignancy
Hemorrhagic cystitis (may be Hemolysis / hemolytic uremic syndrome /
severe) disseminated intravascular coagulation
Vasculitis
Seizures
Raynaud’s
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G - Interactions
Refer to CISplatin, ifosfamide, vinBLAStine, mesna drug monograph(s) for additional details
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H - Drug Administration and Special Precautions
Refer to CISplatin, ifosfamide, vinBLAStine, mesna drug monograph(s) for additional details
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I - Recommended Clinical Monitoring
Recommended Clinical Monitoring
Clinical toxicity assessment (including local toxicity, neurotoxicity, ototoxicity,
cystitis).
CBC before each cycle. Interim counts should be done in first cycle and repeated if
dose modifications necessary.
Baseline and regular liver and renal function tests (including electrolytes and
magnesium), and urinalysis.
Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for
Adverse Events) version
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Any use of the information is subject, at all times, to CCO’s Terms and Conditions.
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J - Administrative Information
Pharmacy Workload (average time per visit) 37.437 minutes
Nursing Workload (average time per visit) 55.667 minutes
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K - References
Loehrer PJ Sr, Lauer R, Roth BJ, et al. Salvage therapy in recurrent germ cell cancer: ifosfamide
and cisplatin plus either vinblastine or etoposide. Ann Intern Med, 1988; 109: 540-546.
April 2016 Replaced regimen category with evidence-informed
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M - Disclaimer
Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public
funding information.
The information set out in the drug monographs, regimen monographs, appendices and symptom management
information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare
providers and is to be used for informational purposes only. The information is not intended to cover all possible uses,
directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate
that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is
not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All
uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information
provided in the Formulary.
The format and content of the drug monographs, regimen monographs, appendices and symptom management
information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of
last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly
evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended
that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.
Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom
management information (for patients), are intended for patients. Patients should always consult with their healthcare
provider if they have questions regarding any information set out in the Formulary documents.
While care has been taken in the preparation of the information contained in the Formulary, such information is
provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory
or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.
CCO and the Formulary’s content providers shall have no liability, whether direct, indirect, consequential, contingent,
special, or incidental, related to or arising from the information in the Formulary or its use thereof, whether based on
breach of contract or tort (including negligence), and even if advised of the possibility thereof. Anyone using the
Any use of the information is subject, at all times, to CCO’s Terms and Conditions.
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information in the Formulary does so at his or her own risk, and by using such information, agrees to indemnify CCO
and its content providers from any and all liability, loss, damages, costs and expenses (including legal fees and
expenses) arising from such person’s use of the information in the Formulary.
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Any use of the information is subject, at all times, to CCO’s Terms and Conditions.
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