Key Terms: Anemia, Chemotherapy, Deoxynucleic acid, Food and Drug Administration, Intravenous, Neutropenia.
Definition
Etoposide is a chemotherapy medicine used to treat cancer by destroying cancerous cells. Etoposide is also sold under the brand name VePesid.
Purpose
Etoposide is approved by the Food and Drug Administration (FDA) to treat refractory testicular cancer and small cell lung cancer. It has also been useful for other types of cancer, including non-small cell cancer, leukemia (acute myeloocytic leukemia), Hodgkin's and non-Hodgkin's lymphoma, muscle, brain tumors, bladder, stomach, Kaposi's sarcoma, Ewing's sarcoma, Wilms' tumor, multiple myeloma, hepatoma, uterine carcinoma, myeloblastoma, mycosis fungoides, neuroblastoma, and prostate cancer. It is presently being studied as a treatment for lung cancer that hsa metastasized to the central nervous system.
Description
Etoposide is formulated as a clear liquid for infusion into a vein and it is also available as a pink capsule form to be taken by mouth. It may also be referred to as VP-16, VP-16-213, and epipodophyllotoxin. Etopophos is a different formulation of the intravenous form of etoposide. Etoposide was originally derived from a plant and has been made for longer than 20 years. Etoposide is a member of the group of chemotherapy drugs known as topoisomerase II inhibitors. Topoisomerase II inhibitors cause breaks in the genetic material (DNA) inside the cancer cells and prevent them from further dividing and multiplying. Then the cells die.
The oral form of etoposide is preferred for longer cycles of treatment, while the intravenous form is used primarily for short-term infusion. Studies indicate that lower doses of oral etoposide are utilized by the body more efficiently than higher doses.
Recommended Dosage
An etoposide dose can be determined using a mathematical calculation that measures a person's body surface area (BSA). This number is dependent upon a patient's height and weight. The larger the person, the greater the body surface area. BSA is measured in the units known as square meter (m2). The body surface area is calculated and then multiplied by the drug dosage in milligrams per square meter (mg/m2). This formula is used to calculate the actual dose a patient is to receive.
To Treat Refractory Testicular Cancer
Etoposide injection dosed at the range of 50–100 mg per square meter per day given into a vein over 30–60 minutes daily for 5 consecutive days, every 3–4 weeks. This is done in combination with other chemotherapy drugs, cisplatin and bleomycin.
Etoposide can also be dosed at 100 mg per square meter per day injected into a vein over 30–60 minutes on day 1, day 3, and day 5.
To Treat Lung Cancer
Etoposide injection dosed at the range of 35 mg per square meter per day is given into a vein infused over 30–60 minutes for 4 consecutive days. It is dosed up to 50 mg per square meter per day given into a vein infused over 30–60 minutes for 5 days in a row. This is usually in combination with other chemotherapy drugs such as cisplatin or carboplatin.
Etoposide phosphate formulation is dosed the same as etoposide, but administered over a shorter period of time. The formulation is often used in transplant patients because it does not need to be mixed in large amounts of intravenous fluid and can be administered over less than 30 minutes, unlike regular etoposide.
Oral etoposide 50mg capsules for lung cancer are dosed by doubling the intravenous dose and rounding the number to the nearest 50 mg.
Patients with kidney problems may receive smaller doses of etoposide than patients with normal kidneys. The doctor will monitor a patient's kidney function prior to therapy by checking certain blood counts. Patients with liver abnormalities may also need dose adjustments of the etoposide.
Precautions
Blood counts will be monitored regularly while on etoposide therapy. During a certain time period after receiving etoposide, there is an increased risk of getting infections. Caution should be taken to avoid unnecessary exposure to crowds and people with infections.
Patients with a known previous allergic reaction to chemotherapy drugs should tell their doctor.
Patients who may be pregnant or are trying to become pregnant should tell their doctor before receiving etoposide. Chemotherapy can cause men and women to be sterile, or unable to have children.
Patients should check with their doctors before receiving live virus vaccines while on chemotherapy.
Patients who develop mouth sores from etoposide treatment should discontinue smoking, drinking alcohol, and eating highly acidic or spicy foods.
Side Effects
The most common side effect from etoposide is low blood counts (myelosuppression). When the white blood cell count is low (neutropenia), patients are at an increased risk for developing a fever and infections. Etoposide also causes the platelet count to fall. Platelets are blood cells in the body that allow for the formation of clots. When the platelet count is low, patients are at an increased risk for bruising and bleeding. Low red blood cell counts (anemia), may also occur due to etoposide administration. Low red counts may make patients feel tired, dizzy, and lacking in energy.
Etoposide infusions, if given too quickly into the vein, can cause a significant drop in blood pressure. This can usually be avoided by administering the etoposide over a time period of at least 30–60 minutes. A patient's blood pressure may be taken when receiving an etoposide infusion. To minimize dizziness from a drop in blood pressure, the patient should sit up slowly following an etoposide infusion.
Etoposide can cause mild to moderate nausea and vomiting. This is more common in patients taking the oral capsules. Patients will be given antiemetics before receiving etoposide to help prevent or decrease this side effect. Hair loss (alopecia) is common with etoposide administration. Diarrhea, loss of appetite (anorexia), and mouth sores are less common but have been reported to occur.
Liver problems may occur due to etoposide administration, though they are mild. The liver returns to normal when the drug is stopped. This side effect is more common with higher etoposide doses.
Males receiving etoposide for testicular cancer typically have a lowered sperm count during chemotherapy. As with liver function, however, testicular function gradually returns to normal after etoposide treatment is stopped. In one group of 38 patients treated for testicular cancer, 13 fathered a total of 16 children within two years after the end of etoposide treatment. None of the children had any birth defects.
Less common neurological side effects caused by etoposide include tingling and numbness of the fingers and toes, dizziness, headache, sleepiness, visual disturbances, and confusion.
Other less common side effects caused by etoposide include rash, itching, sores in the mouth, darkening skin, fever, development of another type of cancer or leukemia, redness and pain at the site of injection into the vein, chest pain, and irregular heart rate.
Rare side effects from using etoposide are allergic, or anaphylactic-type, reactions, which include fever, chills, tongue swelling, shortness of breath, low blood pressure, and increased heart rate.
Interactions
Etoposide, if given with the oral drug warfarin (also known as coumadin), can increase bleeding.
Resources
Books
Beers, Mark H., MD, and Robert Berkow, MD, editors. "Acute Leukemia." Section 11, Chapter 138 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2002.
Beers, Mark H., MD, and Robert Berkow, MD, editors. "Kaposi's Sarcoma." Section 11, Chapter 145 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2002.
Karch, A. M. Lippincott's Nursing Drug Guide. Springhouse, PA: Lippincott Williams & Wilkins, 2003.
Periodicals
Marsh, J. W., M. Donovan, D. R. Burholt, et al. "Metastatic Lung Disease to the Central Nervous System: In vitro Response to Chemotherapeutic Agents." Journal of Neurooncology 66 (January 2004): 81–90.
Pectasides, D., M. Pectasides, D. Farmakis, et al. "Testicular Function in Patients with Testicular Cancer Treated with Bleomycin-Etoposide-Carboplatin (BEC(90)) Combination Chemotherapy." European Urology 45 (February 2004): 187–193.
Toffoli, G., G. Corona, B. Basso, and M. Boiocchi. "Pharmacokinetic Optimisation of Treatment with Oral Etoposide." Clinical Pharmacokinetics 43 (March 2004): 441–466.
Organizations
American Society of Health-System Pharmacists (ASHP). 7272 Wisconsin Avenue, Bethesda, MD 20814. (301) 657-3000.
United States Food and Drug Administration (FDA). 5600 Fishers Lane, Rockville, MD 20857-0001. (888) INFO-FDA.
—Nancy J. Beaulieu, R.Ph., B.C.O.P.; Rebecca J. Frey, PhD
