Etoposide

Indications

Etoposide is used for: Lung cancer, Testicular cancer

Adult Dose

Intravenous 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 Adult: Twice the IV dose, rounded to the nearest 50 mg.

Child Dose

Renal Dose

Renal Impairment CrCl >50 mL/min: Dose adjustment not necessary CrCl 15-50 mL/min: 75% of regular dose CrCl < 15 mL/min: Not studied; consider further dose reductions

Administration

Contra Indications

Hypersensitivity, pregnancy, lactation.

Precautions

Skin reactions may occur with accidental exposure; renal or hepatic disease. Periodic CBCs should be done before, during and after therapy. Increased risk of etoposide-toxicity in patients with low serum albumin. Acrylic material has been shown to crack and leak when used with undiluted etoposide inj. Lactation: not known if excreted in breast milk, discontinue drug or do not nurse

Pregnancy-Lactation

Pregnancy: Based on animal data and its mechanism of action, etoposide can cause fetal harm when administered to a pregnant woman; etoposide, the active moiety of etoposide phosphate is teratogenic in mice and rats advise pregnant women of potential hazard to a fetus; advise women of childbearing potential to avoid becoming pregnant Advise females of reproductive potential to use effective contraception during treatment and for 6 months after final dose In females of reproductive potential, may cause infertility and result in amenorrhea; premature menopause can occur; recovery of menses and ovulation is related to age at treatment Lactation: There is no information regarding presence of etoposide in human milk or its effects on breastfed infant milk production; because of potential for serious adverse reactions in nursing infants, advise women not to breastfeed during treatment with etoposide

Interactions

Synergism with other cytotoxic drugs. Caution when admin with drugs that inhibit phosphatase activity. Cyclosporin A may reduce the clearance of etoposide.

Adverse Effects

Side effects of Etoposide : >10% Leukopenia (60-91%), Nausea and Vomiting (30-40%), Thrombocytopenia (28-41%), Alopecia (20-90%), Anorexia (13%), Diarrhea (13%), Leukopenia (60-91%), Anemia (≤33%) 1-10% Pancytopenia (7%), Stomatitis (6%), Hepatic toxicity (3%), Type 1 hypersensitivity (2%), Orthostatic hypotension (1-2%), Peripheral neuropathy (1-2%) Frequency Not Defined Malaise, Shivering, Asthenia, Fever, Mucous membrane inflammation, Hyperuricemia, Local soft tissue toxicity has been reported following extravasation; see section on IV information for extravasation management Potentially Fatal: Severe myelosuppression, characterised by leucopaenia and thrombocytopaenia. Cardiotoxicity. Anaphylaxis.

Mechanism of Action

Etoposide is a derivative of podophyllotoxin that inhibits DNA synthesis resulting in the arrest of the cell cycle. At low doses, it inhibits cells from entering cell cycle and at high doses, cells entering mitosis are lysed.