BEP

Say it: B-E-P

Bleomycin, etoposide and cisplatin

BEP is a 3 medicine chemotherapy that cures most people with testicular and other germ cell cancers, even when the cancer has spread.

Also called: B-E-P, BEP x3, BEP x4, EP, etoposide and cisplatin, PEB

What it is

Germ cell cancers are very sensitive to chemotherapy, and BEP is the standard plan. Each medicine attacks the cancer in a different way. The goal is cure, and most people are cured. After treatment, any leftover masses may be removed with surgery.

Often used for

• Testicular cancer (germ cell tumor) that has spread
• Germ cell tumors outside the testicle, such as in the chest or belly
• Ovarian germ cell tumors

BEP for 3 cycles

Used for good risk disease. This is about 9 weeks of treatment.

BEP for 4 cycles

Used for intermediate or poor risk disease, based on tumor markers and where the cancer has spread.

EP (no bleomycin)

Etoposide and cisplatin alone for 4 cycles may be used for good risk disease when bleomycin is not safe, such as in people with lung problems.

VIP

Etoposide, ifosfamide and cisplatin may replace BEP when bleomycin should be avoided in intermediate or poor risk disease.

The medicines in this plan

Bleomycin

An antibiotic type of chemotherapy. Given through a vein or as a shot once a week (days 1, 8 and 15, or days 2, 9 and 16).

Etoposide

Chemotherapy given through a vein over about 1 hour on days 1 to 5.

Cisplatin

Platinum chemotherapy given through a vein on days 1 to 5, with lots of IV fluids to protect the kidneys.

How you get it

BEP is given every 21 days. Days 1 to 5 are long infusion days, often 5 to 6 hours each, in the clinic or sometimes in the hospital. Bleomycin is also given once a week. Most people get 3 or 4 cycles, about 9 to 12 weeks. Your schedule may be different.

A typical cycle

Days 1 to 5

Daily clinic visits: IV fluids, nausea medicines, etoposide and cisplatin. Bleomycin is given on one of these days.

Day 8

Short visit for blood tests and bleomycin.

Days 8 to 14

Blood counts are lowest. Watch for fever.

Day 15

Short visit for blood tests and bleomycin.

Days 16 to 21

Recovery before the next cycle. Tumor markers in the blood are checked.

Common side effects and what helps

• Nausea and vomiting, especially during the 5 days. Take nausea medicines on schedule, even on good days.
• Deep tiredness that builds with each cycle. Rest and short walks help.
• Hair loss, usually complete. It grows back after treatment.
• Low blood counts with risk of infection. Wash hands often.
• Ringing in the ears or hearing loss from cisplatin. Tell your team right away.
• Tingling or numbness in hands and feet. Report it at visits.
• Fever or chills after bleomycin. Medicines can help prevent this.
• Darkening of the skin or streaks on the skin from bleomycin. Avoid scratching.
• Loss of appetite and taste changes. Eat small meals often.

Call your care team right away if you have

• A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or chills
• A new dry cough or shortness of breath
• Ringing in the ears or trouble hearing
• Vomiting that keeps you from drinking for a day, or making much less urine
• Chest pain, or swelling, pain or warmth in one leg
• Bleeding or many new bruises
• Muscle cramps, twitching or feeling very weak (signs of low magnesium or salts)

Good to know

• Breathing tests (pulmonary function tests) are done before and sometimes during treatment because bleomycin can harm the lungs.
• Do not smoke. Tell any future surgeon or anesthesia team that you had bleomycin.
• Kidney function, magnesium and other salts are checked often because of cisplatin.
• A hearing test may be done before starting.
• Tumor markers (AFP, beta hCG and LDH) are checked to see how the cancer is responding.
• Bank sperm before starting if you may want children later.

At home

• Drink plenty of fluids, at least 8 to 10 cups a day, unless your team says otherwise.
• Take your nausea medicines on schedule, including any you take for several days after cisplatin.
• Take your temperature if you feel unwell, and call for a fever.
• Avoid smoking and vaping.
• Protect your hearing by avoiding loud noise.

Questions to ask

• Is my cancer good, intermediate or poor risk?
• Will I get 3 or 4 cycles?
• Should I bank sperm before starting?
• How will you watch my lungs, hearing and kidneys?
• Will I need surgery after chemotherapy?
• What long term follow up will I need?

Testicular cancer

Last updated: 2026-10-27. Medically reviewed by Veli Bakalov, MD, medical oncologist (October 2026). General education from Step by Step, the patient portal of HemeOncBuddy.