Indications
Small Cell Lung Cancer: Etoposide Capsules in combination with other approved chemotherapeutic agents as first line treatment in patients with small cell lung cancer.
Etoposide is also indicated in Testicular cancer, Small cell lung cancer
Pharmacology
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.
Dosage And Administration
Intravenous (Adult)-
Small cell lung cancer: 35 mg/m2/day for 4 days to 50 mg/m2/day for 5 days. May repeat course at 3-4 wkly intervals after recovery from any toxicity. Inj must be diluted with 5% dextrose or normal saline to give a final concentration of 0.2-0.4 mg/ml and injected over 30-60 minutes. When given via oral capsules: the recommended dose is twice the IV dose rounded to the nearest 50 mg.
Testicular cancer: For combination therapy: 50-100 mg/m2/day from days 1-5, or 100 mg/m2 on days 1, 3 and 5. May repeat course at 3-4 wkly intervals after recovery from any toxicity. Inj must be diluted with 5% dextrose or normal saline to give a final concentration of 0.2-0.4 mg/ml and injected over 30-60 minutes.
Oral (Adult)-
Small cell lung cancer: Twice the IV dose, rounded to the nearest 50 mg.
Interaction
Synergism with other cytotoxic drugs. Caution when admin with drugs that inhibit phosphatase activity. Cyclosporin A may reduce the clearance of etoposide.
Contraindications
Hypersensitivity, pregnancy, lactation.
Side Effects
Leukopenia, Nausea and Vomiting, Thrombocytopenia, Alopecia, Anorexia, Diarrhea, Leukopenia, Anemia, Pancytopenia, Stomatitis, Hepatic toxicity, Type 1 hypersensitivity, Orthostatic hypotension, Peripheral neuropathy
Malaise,Shivering,Asthenia,Fever,Mucous membrane inflammation, Hyperuricemia, Local soft tissue toxicity has been reported following extravasation;
Pregnancy And Lactation
Pregnancy category D. There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Lactation: not known if excreted in breast milk, discontinue drug or do not nurse
Precautions And Warnings
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.
Therapeutic Class
Cytotoxic Chemotherapy
Use in special populations
Renal impairment: CrCI: 15-50 ml/min- 75% of the recommended dose.