Vepesid

Definition

Etoposide is a chemotherapy medicine used to treat cancer by destroying cancerous cells. Etoposide is also known as 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.

Description

Etoposide is 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.

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 calculates 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 kidneys problems may receive smaller doses of etoposide than patients with kidneys that are normal. 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.

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.

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.

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, 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.

KEY TERMS

Anemia

A red blood cell count that is lower than normal.

Chemotherapy

Specific drugs used to treat cancer.

Deoxynucleic acid (DNA)

Genetic material inside of cells that carries the information to make proteins that are necessary to run the cells and keep the body functioning smoothly.

Food and Drug Administration (FDA)

The government agency that oversees public safety in relation to drugs and medical devices, and gives the approval to pharmaceutical companies for commercial marketing of their products.

Intravenous

To enter the body through a vein.

Neutropenia

A white blood cell count that is lower than normal.

Refractory cancer

Cancer that is not responding to treatment.