• Severe myelosuppression is dose-limiting → monitor FBC before each cycle
• Risk of fatal infections and bleeding due to neutropenia/thrombocytopenia
• Anaphylactic infusion reactions may occur → stop infusion immediately if suspected
• Tumour lysis syndrome (sometimes fatal), especially with high tumour burden
• Secondary acute leukaemia (with or without MDS) reported after etoposide-containing regimens
• Hypotension with rapid IV infusion → must be given as slow IV infusion (30–60 min)
• Severe hepatic dysfunction is a contraindication
• Live vaccines contraindicated during treatment
• Mutagenic and teratogenic → strict contraception required
Generic name: Etoposide
Brand name: Etoposide-Hexal®
Drug class: Cytotoxic chemotherapy (topoisomerase II inhibitor)
Formulation: Concentrate for solution for IV infusion
Strengths:
• 50 mg / 2.5 mL
• 100 mg / 5 mL
• 200 mg / 10 mL
• 400 mg / 20 mL
• 1000 mg / 50 mL
Mechanism of Action:
Etoposide forms a complex with DNA and topoisomerase II, causing double-strand DNA breaks, leading to inhibition of DNA synthesis and cell death. Cytotoxicity is greatest in the S and G2 phases of the cell cycle.
ETOPOSIDE-HEXAL is indicated for the management of:
• First-line treatment of testicular tumours
– Used intravenously in combination with other approved chemotherapeutic agents
• Refractory testicular tumours
– In combination with other approved medicines
– For patients who have previously received appropriate surgery, chemotherapy and radiotherapy
• Small cell anaplastic lung tumours
– Used in combination with other approved chemotherapeutic agents
• Malignant (non-Hodgkin’s) lymphomas,
– Particularly the histiocytic (large cell diffuse) variety
– Used in combination with other approved chemotherapeutic agents
Route: Intravenous infusion only
Typical dosing schedules:
• 50–100 mg/m²/day on Days 1–5, or
• 100 mg/m²/day on Days 1, 3, and 5
Cycle:
• Repeated every 3–4 weeks
• Always used as part of combination chemotherapy
Administration notes:
• Infuse slowly over 30–60 minutes
• Do NOT give as IV bolus
• Monitor infusion site closely (vesicant/irritant risk)
• Bone marrow suppression:
– Delay or reduce dose if neutrophils < 1,500/mm³ or platelets < 100,000/mm³ (unless disease-related)
• Renal impairment:
– Creatinine clearance 15–50 mL/min → give 75% of dose
– <15 mL/min → further dose reduction should be considered
• Other Grade 3–4 toxicities:
– Hold treatment and resume at reduced dose once resolved
• Hypersensitivity to etoposide or excipients
• Severe hepatic dysfunction
• Severe bone marrow depression
• Significant renal impairment
• Active chickenpox or herpes zoster
• Concomitant use of live vaccines (e.g. yellow fever)
• Pregnancy and breastfeeding
• FBC: Baseline and before each cycle
• Renal function: Baseline and periodically
• Liver function: Baseline and periodically
• Signs of infection or bleeding
• Blood pressure during infusion
• Electrolytes and uric acid in high tumour burden (TLS risk)
Very Common / Common:
• Myelosuppression (neutropenia, thrombocytopenia, anaemia)
• Infections and fever
• Nausea and vomiting
• Mucositis, stomatitis, oesophagitis
• Alopecia
• Fatigue, malaise
• Hypotension (during infusion)
Serious:
• Anaphylactic reactions
• Tumour lysis syndrome
• Secondary acute leukaemia
• Severe hepatotoxicity
• Stevens–Johnson syndrome / TEN
• Cardiac arrhythmias, myocardial infarction
• Severe extravasation injury
• Cisplatin → reduced etoposide clearance
• Phenytoin → reduced etoposide efficacy
• Ciclosporin (high dose) → ↑ etoposide exposure
• Warfarin → ↑ INR (monitor closely)
• Other myelosuppressive agents → additive toxicity
• Live vaccines → contraindicated
• Pregnancy: Contraindicated (foetal harm)
• Breastfeeding: Contraindicated
• Paediatrics: Safety and efficacy not established
• Elderly: Use with caution; monitor marrow reserve
• Renal impairment: Dose adjustment required
• Hepatic impairment: Use with extreme caution
Continue until:
• Completion of planned chemotherapy regimen, or
• Disease progression, or
• Unacceptable toxicity
Permanently discontinue if:
• Severe, persistent myelosuppression
• Life-threatening hypersensitivity
• Severe organ toxicity
• Development of secondary malignancy
| Trade Name | |
|---|---|
| Drug Class | 1 |
| Cost | |
| Company | |
|---|---|
| Drug Rep | Admin |
| Indications | Lung Cancer, Lymphoma, Testicular Cancer |
| Dosage |