Etoposide

Etoposide is used to treat different cancers of lung, and testicles. It is also sometimes used to treat some other kinds of cancer in both men and women. It can be used on its own, or sometimes given together with certain other medicines as part of combination chemotherapy.

Etoposide is given as slow injection into veins under the supervision of a healthcare professional and should not be self-administered. Your doctor will decide what dose is necessary and how often you need to take it.

• Small Cell Lung Cancer: Used in combination with other approved chemotherapeutic agents as first-line treatment.
• Testicular Cancer: Used for treatment of testicular cancer.

Cytotoxic Chemotherapy

Podophyllotoxin Derivative (Topoisomerase II Inhibitor)

Etoposide is a semisynthetic derivative of podophyllotoxin used in the treatment of certain neoplastic diseases. Podophyllotoxins inhibit mitosis by blocking microtubular assembly. Etoposide inhibits cell cycle progression at a premitotic phase (late S and G2).

Etoposide suppresses the activity of topoisomerase II enzyme involved in DNA multiplication, slowing the growth of cancer cells and eventually killing them.

Adult Dose (IV):

• Testicular Cancer: 50-100 mg/m²/day IV on days 1-5, OR 100 mg/m²/day IV on days 1, 3, 5; repeat q3-4week.
• Small-Cell Lung Cancer: 35 mg/m²/day IV for 4 days, OR 50 mg/m²/day IV for 5 days; repeat q3-4week.
• Oral (Small cell lung cancer): Twice the IV dose, rounded to the nearest 50 mg.

Renal Dose: CrCl >50 mL/min: No adjustment; CrCl 15-50 mL/min: 75% of regular dose.

Your doctor or nurse will give you this medicine. Kindly do not self administer.

If you miss a dose of Etoposide, please consult your doctor.

Common Side Effects:

• Anemia (low number of red blood cells)
• Decreased blood cells (red cells, white cells, and platelets)
• Decreased white blood cell count
• Diarrhea
• Hair loss
• Liver damage
• Low blood platelets
• Nausea
• Rash
• Stomatitis (Inflammation of the mouth)
• Vomiting

Hematologic Toxicity: Myelosuppression is dose related and dose limiting; granulocyte nadirs 7-14 days, platelet nadirs 9-16 days.

Precautions:

• Etoposide does not usually affect your ability to drive.
• Frequent observation for myelosuppression during and after therapy required.
• Platelet count below 50,000/mm3 or ANC below 500/mm3: withhold further therapy.
• Risk of anaphylactic reaction (chills, fever, tachycardia, bronchospasm, dyspnea, hypotension).
• Administer only by slow intravenous infusion (30-60 minutes).
• In severe reactions, reduce dose or discontinue.
• Caution in liver and kidney disease.

Contraindications:

• Hypersensitivity
• Pregnancy
• Lactation

Drug Interactions:

• Other cytotoxic drugs: Synergism.
• Drugs that inhibit phosphatase activity: Caution.
• Cyclosporin A: May reduce clearance of etoposide.

Food Interactions: It is not known whether it is safe to consume alcohol with Etoposide. Consult your doctor.

Use in Pregnancy: Category D; unsafe due to definite evidence of risk to the developing baby.

Use in Lactation: Unsafe; data suggests drug may cause toxicity to the baby.

Pediatric Use: Safety and efficacy not established.

Geriatric Use: No specific dosage adjustment is necessary for elderly patients.

Renal Impairment: Use with caution; CrCl 15-50 mL/min: 75% of dose; end-stage kidney disease: not recommended.

Hepatic Impairment: Use with caution; severe liver disease: not recommended.

Overdose: Limited information; overdose may cause myelosuppression; symptomatic treatment.

Storage: Store under refrigeration 2-8 degree C. Protect from light. Keep out of reach of children.

Etoposide