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Systemic Anti-Cancer Therapy Regimen Library

Home > GU GCT Metastatic - TIP [PACLItaxel, IFOSFamide and cISplatin]

GU GCT Metastatic - TIP [PACLItaxel, IFOSFamide and cISplatin]

Treatment Overview

This regimen contains a medicine where one or more biosimilars may exist. Any biosimilars used have been reviewed by the regulator (Medsafe) and relevant specialists were consulted nationally. Where regulators, in consultation with relevant specialists, have agreed that there are no clinically significant differences in either safety or effectiveness between a biosimilar and originator product, these drugs may be used interchangeably.

Cycles 1 to 3 - 21 days

Cycle length:
21

PACLItaxel: Different doses (175 mg/m2 to 250 mg/m2) and dose schedules (3 hour infusion and 24 hour infusion) have been used.

Cycle details

Cycles 1 to 3 - 21 days

Medication Dose Route Days Max Duration
dexamethasone * 20 mg oral administration 0
dexamethasone * 12 mg oral administration 1
loratadine * 10 mg oral administration 1
famotidine * 20 mg oral administration 1
PACLItaxel * 250 mg/m² intravenous 1 24 hours Min: 24 hours
olanzapine * 5 mg oral administration 2 to 8
aprepitant 125 mg oral administration 2
aprepitant 80 mg oral administration 3, 4
dexamethasone * 8 mg oral administration 2 to 8
ondansetron 8 mg oral administration 2 to 5
magnesium sulfate heptahydrate 10 mmol intravenous 2 to 5 60 minutes
cISplatin 25 mg/m² Once daily intravenous 2 to 5 60 minutes
sodium chloride 0.9 % intravenous 2 to 5 60 minutes
mesna 500 mg/m² intravenous 2 to 5 15 minutes
IFOSFamide * 1500 mg/m² Once daily intravenous 2 to 5 120 minutes
sodium chloride 0.9 % intravenous 2 to 5 60 minutes
mesna 500 mg/m² intravenous 2 to 5 15 minutes
mesna 500 mg/m² intravenous 2 to 5 15 minutes
ondansetron 8 mg oral administration 2 to 5
pegFILGRASTIM 6 mg subcutaneous injection 6
cyclIZINE 50 mg Three times daily oral administration 1
docusate sodium + sennoside B 2 Tablet(s) oral administration 1

PACLItaxel: Different doses (175 mg/m2 to 250 mg/m2) and dose schedules (3 hour infusion and 24 hour infusion) have been used.

Full details

Cycles 1 to 3 - 21 days

Day: 0

Medication Dose Route Max duration Details
dexamethasone * 20 mg oral administration
Instructions:

Take the night prior to PACLItaxel infusion with food.

If the initial infusion(s) of PACLItaxel are well tolerated, clinicians may decide at their discretion, to omit this dose.

Day: 1

Medication Dose Route Max duration Details
dexamethasone * 12 mg oral administration
Instructions:

ONE hour prior to chemotherapy with food.
loratadine * 10 mg oral administration
Instructions:

ONE hour prior to PACLItaxel infusion.
famotidine * 20 mg oral administration
Instructions:

ONE hour prior to PACLItaxel infusion.

Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
PACLItaxel * 250 mg/m² intravenous 24 hours Min: 24 hours
Instructions:

Continuous infusion over 24 hours.

  • Prepare solution in PVC-free bag and administer via polyethylene lined administration set with an in-line filter of 0.22 microns or less in size.
  • Please carry out graded challenge as per institutional policy.
cyclIZINE 50 mg Three times daily oral administration
Instructions:

When required for nausea and/or vomiting.

  • Warning: may cause drowsiness.
  • Consider starting dose at 25 mg and increasing as tolerated/required.
  • The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics.
  • Note that domperidone is not recommended in combination with olanzapine and ondansetron due to potential risk of QT prolongation.
docusate sodium + sennoside B 2 Tablet(s) oral administration
Instructions:

At night when required for constipation.

Each tablet contains docusate sodium 50 mg + sennoside B 8 mg.

Day: 2

Medication Dose Route Max duration Details
olanzapine * 5 mg oral administration
Instructions:

ONE hour prior to chemotherapy.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
  • Some centres may choose to omit pre-chemotherapy dose or advise patient to take the night before chemotherapy if patient has to drive to appointment.
aprepitant 125 mg oral administration
Instructions:
ONE hour prior to chemotherapy.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.
ondansetron 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.
magnesium sulfate heptahydrate 10 mmol intravenous 60 minutes
Instructions:
In 1000 mL of sodium chloride 0.9%, prior to cISplatin infusion.
cISplatin 25 mg/m² Once daily intravenous 60 minutes
Instructions:
  • In 500 - 1000 mL of sodium chloride 0.9%, depending on stability.
  • Ensure patient has passed urine as per institutional policy.
  • Hypersensitivity risk increases with number of cycles of cISplatin.
sodium chloride 0.9 % intravenous 60 minutes
Quantity:500 mL
Instructions:

After cISplatin infusion.
mesna 500 mg/m² intravenous 15 minutes
Instructions:

15 minutes prior to IFOSFamide infusion over 15 minutes, or as per institutional practice.
IFOSFamide * 1500 mg/m² Once daily intravenous 120 minutes
sodium chloride 0.9 % intravenous 60 minutes
Quantity:500 mL
Instructions:

After IFOSFamide infusion.

Recommended daily hydration is 3000 ml per day as oral or IV fluid on day(s) of IFOSFamide and for 24 hours after, or as per institutional practice.
mesna 500 mg/m² intravenous 15 minutes
Instructions:

At 4 hours from the start of IFOSFamide infusion, or as per institutional practice.
mesna 500 mg/m² intravenous 15 minutes
Instructions:

At 8 hours from the start of IFOSFamide infusion, or as per institutional practice.
ondansetron 8 mg oral administration
Instructions:

EIGHT hours after chemotherapy OR before bed.

Day: 3

Medication Dose Route Max duration Details
olanzapine * 5 mg oral administration
Instructions:

ONCE daily.

This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
aprepitant 80 mg oral administration
Instructions:
ONCE daily in the morning.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

Dose and duration may be individualised at clinician’s discretion.
ondansetron 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.
magnesium sulfate heptahydrate 10 mmol intravenous 60 minutes
Instructions:
In 1000 mL of sodium chloride 0.9%, prior to cISplatin infusion.
cISplatin 25 mg/m² Once daily intravenous 60 minutes
Instructions:
  • In 500 - 1000 mL of sodium chloride 0.9%, depending on stability.
  • Ensure patient has passed urine as per institutional policy.
  • Hypersensitivity risk increases with number of cycles of cISplatin.
sodium chloride 0.9 % intravenous 60 minutes
Quantity:500 mL
Instructions:

After cISplatin infusion.
mesna 500 mg/m² intravenous 15 minutes
Instructions:

15 minutes prior to IFOSFamide infusion over 15 minutes, or as per institutional practice.
IFOSFamide * 1500 mg/m² Once daily intravenous 120 minutes
sodium chloride 0.9 % intravenous 60 minutes
Quantity:500 mL
Instructions:

After IFOSFamide infusion.

Recommended daily hydration is 3000 ml per day as oral or IV fluid on day(s) of IFOSFamide and for 24 hours after, or as per institutional practice.
mesna 500 mg/m² intravenous 15 minutes
Instructions:

At 4 hours from the start of IFOSFamide infusion, or as per institutional practice.
mesna 500 mg/m² intravenous 15 minutes
Instructions:

At 8 hours from the start of IFOSFamide infusion, or as per institutional practice.
ondansetron 8 mg oral administration
Instructions:

EIGHT hours after chemotherapy OR before bed.

Day: 4

Medication Dose Route Max duration Details
olanzapine * 5 mg oral administration
Instructions:

ONCE daily.

This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
aprepitant 80 mg oral administration
Instructions:
ONCE daily in the morning.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

Dose and duration may be individualised at clinician’s discretion.
ondansetron 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.
magnesium sulfate heptahydrate 10 mmol intravenous 60 minutes
Instructions:
In 1000 mL of sodium chloride 0.9%, prior to cISplatin infusion.
cISplatin 25 mg/m² Once daily intravenous 60 minutes
Instructions:
  • In 500 - 1000 mL of sodium chloride 0.9%, depending on stability.
  • Ensure patient has passed urine as per institutional policy.
  • Hypersensitivity risk increases with number of cycles of cISplatin.
sodium chloride 0.9 % intravenous 60 minutes
Quantity:500 mL
Instructions:

After cISplatin infusion.
mesna 500 mg/m² intravenous 15 minutes
Instructions:

15 minutes prior to IFOSFamide infusion over 15 minutes, or as per institutional practice.
IFOSFamide * 1500 mg/m² Once daily intravenous 120 minutes
sodium chloride 0.9 % intravenous 60 minutes
Quantity:500 mL
Instructions:

After IFOSFamide infusion.

Recommended daily hydration is 3000 ml per day as oral or IV fluid on day(s) of IFOSFamide and for 24 hours after, or as per institutional practice.
mesna 500 mg/m² intravenous 15 minutes
Instructions:

At 4 hours from the start of IFOSFamide infusion, or as per institutional practice.
mesna 500 mg/m² intravenous 15 minutes
Instructions:

At 8 hours from the start of IFOSFamide infusion, or as per institutional practice.
ondansetron 8 mg oral administration
Instructions:

EIGHT hours after chemotherapy OR before bed.

Day: 5

Medication Dose Route Max duration Details
olanzapine * 5 mg oral administration
Instructions:

ONCE daily.

This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

Dose and duration may be individualised at clinician’s discretion.
ondansetron 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.
magnesium sulfate heptahydrate 10 mmol intravenous 60 minutes
Instructions:
In 1000 mL of sodium chloride 0.9%, prior to cISplatin infusion.
cISplatin 25 mg/m² Once daily intravenous 60 minutes
Instructions:
  • In 500 - 1000 mL of sodium chloride 0.9%, depending on stability.
  • Ensure patient has passed urine as per institutional policy.
  • Hypersensitivity risk increases with number of cycles of cISplatin.
sodium chloride 0.9 % intravenous 60 minutes
Quantity:500 mL
Instructions:

After cISplatin infusion.
mesna 500 mg/m² intravenous 15 minutes
Instructions:

15 minutes prior to IFOSFamide infusion over 15 minutes, or as per institutional practice.
IFOSFamide * 1500 mg/m² Once daily intravenous 120 minutes
sodium chloride 0.9 % intravenous 60 minutes
Quantity:500 mL
Instructions:

After IFOSFamide infusion.

Recommended daily hydration is 3000 ml per day as oral or IV fluid on day(s) of IFOSFamide and for 24 hours after, or as per institutional practice.
mesna 500 mg/m² intravenous 15 minutes
Instructions:

At 4 hours from the start of IFOSFamide infusion, or as per institutional practice.
mesna 500 mg/m² intravenous 15 minutes
Instructions:

At 8 hours from the start of IFOSFamide infusion, or as per institutional practice.
ondansetron 8 mg oral administration
Instructions:

EIGHT hours after chemotherapy OR before bed.

Day: 6

Medication Dose Route Max duration Details
olanzapine * 5 mg oral administration
Instructions:

ONCE daily.

This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

Dose and duration may be individualised at clinician’s discretion.
pegFILGRASTIM 6 mg subcutaneous injection

Day: 7

Medication Dose Route Max duration Details
olanzapine * 5 mg oral administration
Instructions:

ONCE daily.

This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

Dose and duration may be individualised at clinician’s discretion.

Day: 8

Medication Dose Route Max duration Details
olanzapine * 5 mg oral administration
Instructions:

ONCE daily.

This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

Dose and duration may be individualised at clinician’s discretion.

Supportive Care Factors

Factor Value
Constipation risk: laxatives are usually prescribed
Emetogenicity: Variable
Growth factor support: Recommended for primary prophylaxis
Hydration: Routine hydration recommended
Hypersensitivity / Infusion related reaction risk: High - routine premedication recommended
Mesna uroprotection: Routine mesna uroprotection recommended

Emetogenicity: LOW day 1; HIGH days 2 to 5.

References

Kondagunta, G. V., J. Bacik, A. Donadio, et al. 2005. "Combination of paclitaxel, ifosfamide, and cisplatin is an effective second-line therapy for patients with relapsed testicular germ cell tumors." J Clin Oncol 23(27):6549-6555. , PMID: 16170162

Mead, G. M., M. H. Cullen, R. Huddart, et al. 2005. "A phase II trial of TIP (paclitaxel, ifosfamide and cisplatin) given as second-line (post-BEP) salvage chemotherapy for patients with metastatic germ cell cancer: a medical research council trial." Br.J.Cancer. 93(2):178-184. , PMID: 15999102

Mardiak, J., T. Salek, Z. Sycova-Mila, et al. 2005. "Paclitaxel plus ifosfamide and cisplatin in second-line treatment of germ cell tumors: a phase II study." Neoplasma 52(6):497-501. , PMID: 16284696

Kurobe, M., K. Kawai, T. Oikawa, et al. 2015. "Paclitaxel, ifosfamide, and cisplatin (TIP) as salvage and consolidation chemotherapy for advanced germ cell tumor." J Cancer Res Clin Oncol 141(1):127-133. , PMID: 25062721

Park, S., S. Lee, J. Lee, et al. 2011. "Salvage chemotherapy with paclitaxel, ifosfamide, and cisplatin (TIP) in relapsed or cisplatin-refractory germ cell tumors." Onkologie 34(8-9):416-420., PMID: 21934340

Motzer, R. J., J. Sheinfeld, M. Mazumdar, et al. 2000. "Paclitaxel, ifosfamide, and cisplatin second-line therapy for patients with relapsed testicular germ cell cancer." J Clin Oncol 18(12):2413-2418., PMID: 10856101

Lorch, A., C. Bascoul-Mollevi, A. Kramar, et al. 2011. "Conventional-dose versus high-dose chemotherapy as first salvage treatment in male patients with metastatic germ cell tumors: evidence from a large international database." J Clin Oncol 29(16):2178-2184., PMID: 21444870

Novartis New Zealand Ltd. Paclitaxel Ebewe New Zealand Data Sheet 16 April 2020. https://www.medsafe.govt.nz/profs/Datasheet/p/PaclitaxelEbeweinj.pdf (Accessed 4 October 2022).

Tabernero J, Vyas M, Giuliani R, Arnold D, Cardoso F, Casali PG, Cervantes A, Eggermont AMM, Eniu A, Jassem J, Pentheroudakis G, Peters S, Rauh S, Zielinski CC, Stahel RA, Voest E, Douillard JY, McGregor K, Ciardiello F. Biosimilars: a position paper of the European Society for Medical Oncology, with particular reference to oncology prescribers. ESMO Open. 2017 Jan 16;1(6):e000142. doi: 10.1136/esmoopen-2016-000142., PMID: 28848668

Lyman GH, Balaban E, Diaz M, Ferris A, Tsao A, Voest E, Zon R, Francisco M, Green S, Sherwood S, Harvey RD, Schilsky RL. American Society of Clinical Oncology Statement: Biosimilars in Oncology. J Clin Oncol. 2018 Apr 20;36(12):1260-1265. doi: 10.1200/JCO.2017.77.4893. Epub 2018 Feb 14., PMID: 29443651

Boulanger J, Boursiquot JN, Cournoyer G, et al. Management of hypersensitivity to platinum- and taxane-based chemotherapy: cepo review and clinical recommendations. Curr Oncol. 2014;21(4):e630-e641., PMID: 25089112 

Castells, M.C., Matulonis, U.A., and Horton, TM. Infusion reactions to systemic chemotherapy. Savarese DMF and Feldweg AM, ed. UpToDate. Waltham, MA: UpToDate Inc. https://wwwuptodate.com (Accessed 26 March 2021).

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.